2022 Fifth Annual Medical Student Research Day Program and Abstract Book

Fifth Annual KAREN ZIER PHD MEDICAL STUDENT RESEARCH DAY

Program and Abstracts THURSDAY, MARCH 17, 2022, 12:15 – 4:00 PM

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TABLE OF CONTENTS — Introduction (pg 4) — Program and Student Speakers (pg 5-6) — List of Abstracts (Section 1: pg 7-35) — Abstracts (Section 2: pg 37-174) — Student Index (Section 3: pg 176-183) — Mentor Index (Section 4: pg 185-191) — Abstract Topics Area (Section 5: pg 193-195) — Acknowledgements (Section 6: pg 197-199)

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Fifth Annual Karen Zier Medical Student Research Day March 17, 2022

Welcome to the 27th Annual Medical Student Research Day, named in honor of Karen Zier, PhD, founding Associate Dean for the Medical Student Research Office. Last year we held it virtually and it was an enormous success. With two years of social distancing, we are planning to hold it in-person if it is safe to do so. It will be great to see your faces in 3-D, even if it is masked.

The Icahn School of Medicine at Mount Sinai places immense importance on rigorous, mentored scholarship in the education of future physicians. The Medical Student Research Office supports this mission through the Scholarship and Research (SCHOLaR) program, which provides students research curricular training, helps to identify a research mentor, and supports the development of a rigorous research project in their area of interest.

Student scholarship is supported by several programs, including the Summer Research Investigators Program, the Scholarly Year Program, and PORTAL (Patient-Oriented Research, Training, and Leadership) which offers a combined MD-Masters of Science in Clinical Research. Additional support is available to students participating in research through the Global Health Summer Program, and Center for Multicultural and Community Affairs (CMCA), the Diversity Innovation Hub (DIH), and more. The projects presented reflect the intellectual curiosity and critical thinking of our students and are a result of their hard work and the dedication of their faculty mentors.

The medical student research program flourishes because of the enthusiasm of our students, the support of school leadership, and the commitment of dedicated faculty mentors. We are grateful for the support of Dr. Dennis Charney, Dean of the Icahn School of Medicine at Mount Sinai, and Dr. David Muller, Dean for Medical Education. We would like to send a special thank you to the SCHOLaR Track Advisors for their dedicated support making this day possible:

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—Jacob Appel, MD, MS, MPH —Supinda Bunyavanich, MD —Kevin Costa, PhD —Darinka Gadikota-Klumpers, PhD —Leona Hess, PhD —James Iatridis, PhD —Reena Karani, MD, MHPE —Tatyana Kushner, MD, MSCE —Ann-Gel Palermo, DrPH —Paz Polak, PhD —Perry Sheffield, MD

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—Rainer Soriano, MD

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Thank you Grace Oluoch and Yakhira Encarnacion-Patterson, Program Administrators for the Medical Student Research Office, for producing the abstract book and the Research Day planning and organization.

Jenny J. Lin, MD, MPH

Keith Sigel, MD, PhD

Mary Rojas, PhD

Co-Director of SCHOLaR

Director of PORTAL

Director of the MSRO

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PROGRAM

12:15 – 1:15 pm In-Person - Poster Presentations (Session A)

1:25 – 2:25 pm In-Person - Poster Presentations (Session B)

Welcome

2:35–4:00 pm Platform Presentations via Zoom Zoom Webinar ID: 836 8607 0084 Passcode: 735237

Student Speakers

Mary Rojas, PhD

Lauren Alpert, MS II

Director, Medical Student Research Office Icahn School of Medicine at Mount Sinai

“Associations between Prenatal Exposure to Fine Particulate Matter and Age Four Impulse Oscillometry: Effect Modification by Maternal Atopy”

David Muller, MD Dean for Medical Education Icahn School of Medicine at Mount Sinai

MENTOR: ALISON LEE, MD

Zakaria Chakrani, MS II Dennis Charney, MD Anne and Joel Ehrenkranz Dean Icahn School of Medicine at Mount Sinai President for Academic Affairs Mount Sinai Health System

“Prolonged Opioid Use after ORIF of Tibial Shaft Fractures” MENTOR: DAVID FORSH, MD

Liza Magill, MS II “Characterizing Non-Responders to an HIV Disclosure Intervention for Caregivers of Children with HIV: A Post-Hoc Analysis of a Cluster Randomized Trial in Eldoret, Kenya” MENTOR: RACHEL VREEMAN, MD, MS

Amara Plaza-Jennings, MSTP Student “Altered Microglial Genome Structure and Transcription in HIV Encephalitis Impact HIV Integration” MENTOR: SCHAHRAM AKBARIAN, MD, PHD

Closing Remarks

Mary Rojas, PhD 5

STUDENT SPEAKERS

LAUREN ALPERT, MS II “ Associations between Prenatal Exposure to Fine Particulate Matter and Age Four Impulse Oscillometry: Effect Modification by Maternal Atopy” Abstract #: 6

ZAKARIA CHAKRANI, MS II “ Prolonged Opioid Use after ORIF of Tibial Shaft Fractures” Abstract #: 19 MENTOR: DAVID FORSH, MD

MENTOR: ALISON LEE, MD

LIZA MAGILL, MS II “ Characterizing Non-Responders to an HIV Disclosure Intervention for Caregivers of Children with HIV: A Post-Hoc Analysis of a Cluster Randomized Trial in Eldoret, Kenya” Abstract # 80 MENTOR: RACHEL VREEMAN, MD, MS

AMARA PLAZA-JENNINGS, MSTP “ Altered Microglial Genome Structure and Transcription in HIV Encephalitis Impact HIV Integration” Abstract #: 93 MENTOR: SCHAHRAM AKBARIAN, MD, PHD

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SECTION 1:

List of Abstracts Note: Medical student’s name is in bold and the last author is the mentor.

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LIST OF ABSTRACTS

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DELAY IN CARE FOR APPENDICITIS DURING THE COVID-19 PANDEMIC. Ava Adler1, Shruti Zaveri2, Venu Bangla2, Sean Johnson2, Alycia So2, Tyler D’Ovidio3, Celia Divino2. 1Medical Education, 2Surgery. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY.

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ROLE FOR POLYCOMB REPRESSIVE COMPLEX 2 (PRC2) MEDIATED GENE REGULATION IN HUNTINGTON’S DISEASE. Sahil Agrawal1, Yong Loh2, Anne Schaefer2. 1Medical Education, 2 Neuroscience. 1,2Icahn School of Medicine at Mount Sinai, New York, NY.

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FLAVOPROTEIN FLUORESCENCE (FPF) MONITORING IN PATIENTS WITH EXUDATIVE AGE-RELATED MACULAR DEGENERATION (AMD) BEFORE AND AFTER ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR (ANTI-VEGF) TREATMENT. Sofia Ahsanuddin1, Oscar Otero-Marquez2, Collin Rich3, Richard Rosen4.

1 Medical Education, 2,3,4Ophthalmology. 1,4Icahn School of Medicine at Mount Sinai, New York, NY, 2New York Eye and Ear Infirmary of Mount Sinai, New York, NY, 3 OcuSciences Inc., Ann Arbor, MI. CERVICAL EPIDURAL STEROID INJECTIONS (CESI) ARE NOT ASSOCIATED WITH INCREASED RISK OF INFECTION, EPIDURAL HEMATOMA, REVISION RATES, WOUND COMPLICATIONS OR COMBINED COMPLICATIONS IN ANTERIOR CERVICAL DISCECTOMY AND FUSION (ACDF).

Husni Alasadi1, Zakaria Chakrani1, Nicole Zubizarreta2, Jashvant Poeran2, Saad Chaudhary2. 1Medical Education, 2Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. SYNERGY OF CAD INHIBITION AND ERASTIN IN PTEN DEFICIENT CELLS. David Allely1, Kaitlyn Fragogiannis2, Ramon Parsons2. 1Medical Education, 2 Oncological Sciences. 1,2Icahn School of Medicine at Mount Sinai, New York, NY.

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LIST OF ABSTRACTS

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ASSOCIATIONS BETWEEN PRENATAL EXPOSURE TO FINE PARTICULATE MATTER AND AGE FOUR IMPULSE OSCILLOMETRY: EFFECT MODIFICATION BY MATERNAL ATOPY. Lauren Alpert1, Maritza Minchala2, Elena Colicino3, Ander Wilson4, Brent Coull5, Rosalind Wright2, Alison Lee2. 1Medical Education, 2Pediatrics, 3Environmental Medicine & Public Health. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY, 4 Colorado State University, 5Harvard University.

THE DISAPPEARING ACT: MR IMAGING OF SCARPA’S FASCIA IN THE PERIUMBILICAL REGION FOR AUTOLOGOUS BREAST RECONSTRUCTION DECISION MAKING. Uchechukwu Amakiri1, Florence Doo2, Annet Kuruvilla3, Alexander Kagen2, Peter Henderson4. 1Medical Education, 2Radiology, 4Surgery. 1,4Icahn School of Medicine at Mount Sinai, New York, NY, 2Mount Sinai West, 3Stony Brook University Renaissance School of Medicine New York, NY.

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EFFECTS OF PREGNANCY ON THE PHARMACOKINETICS OF ANTI-TNF BIOLOGICS IN WOMEN WITH INFLAMMATORY BOWEL DISEASE. Lily Ardente1, Gottlieb Zoe3, Marla Dubinsky2. 1Medical Education, 2Pediatics, 3 Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, NY.

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USE OF VIRTUAL PLATFORM FOR DELIVERY OF SIMULATION-BASED LAPAROSCOPIC TRAINING CURRICULUM TO LMICS. Zerubabbel Asfaw1, Rachel Todd1, Linda Zhang2. 1Medical Education, 2 Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, NY.

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ACCESS TO HORMONE THERAPY FOR THE TRANSGENDER COMMUNITY DURING COVID-19.

Nicholas Athayde-Rizzaro1, Mary Rojas1.1Medical Education.

1 Icahn School of Medicine at Mount Sinai, New York, NY.

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LIST OF ABSTRACTS

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MEDICAL MISTRUST AND PALLIATIVE CARE PERCEPTIONS IN RACIALLY AND ETHNICALLY DIVERSE PATIENTS WITH ADVANCED STAGE LUNG CANCER. Amina Avril1, Melissa Mazor2, Jose Morillo2, Cardinale Smith2. 1Medical Education, 2Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. SARS-COV-2 MRNA VACCINATION ELICITS ROBUST SPIKE ANTIBODY RESPONSES IN PEOPLE WITH HIV. Arman Azad1, María Carolina Bermúdez González2, Komal Srivastava2, Charles Gleason2, Katherine Beach2, Levy Sominsky2, Annika Oostenink2, Gianna Cai2, Juan Manuel Carreño Quiroz2, Dominika Bielak2, Gagandeep Singh2, PVI Study Group2, Florian Krammer3, Luz Amarilis Lugo3, Viviana Simon2. 1Medical Education, 2Microbiology,3Infectious Diseases. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. ILIAC VEIN STENOSIS ACCENTUATED SYMPTOMS OF THORACIC OUTLET SYNDROME. Halbert Bai1, Arthur Jenkins2, Michael Marin3, Windsor Ting3. 1Medical Education, 2Neurosurgery, 3Surgery. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. CARDIAC CORONARY TOMOGRAPHY ANGIOGRAPHY (CCTA) USE ACROSS GEOGRAPHIC REGIONS IN THE UNITED STATES AND THE UNITED KINGDOM. Bryana Banashefski1, Rita Redberg2. 1Medical Education, 2Cardiology. 1Icahn School of Medicine at Mount Sinai, New York, NY, 2UCSF, San Francisco, California.

IMPACT OF BOVINE MILK EXTRACELLULAR VESICLES AND THEIR MICRORNA CARGOES ON HUMAN CARDIAC FIBROBLASTS. Nestor Bedoya1, Yassine Sassi2. 1Medical Education, 2Pharmacology and Systems Therapeutics. 1Icahn School of Medicine at Mount Sinai, New York, NY, 2 Fralin Biomedical Research Institute at VTC (Virginia Tech).

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LIST OF ABSTRACTS

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IMPACT OF AN INTERDISCIPLINARY CARE PROGRAM ON PSYCHOSOCIAL OUTCOMES IN PATIENTS WITH RECENTLY DIAGNOSED INFLAMMATORY BOWEL DISEASE. Caroline Benson1, Laurie Keefer2, William Rivera Carrero2, Ryan Ungaro2.

1 Medical Education, 2Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. A SYSTEMATIC REVIEW OF MALNUTRITION ASSESSMENT TOOLS IN THE PEDIATRIC POPULATION. Suzannah Bergstein1, Celine Soudant2, Mirna Chehade3.

1 Medical Education, 3Pediatrics. 1,3Icahn School of Medicine at Mount Sinai, New York, NY, 2Memorial Sloan Kettering New York, NY. NATIONAL ANALYSIS OF RECONSTRUCTIVE AND SALVAGE HIP SURGERIES IN CHILDREN WITH CEREBRAL PALSY. Liam Butler1, Calista Dominy1, Thomas Li1, Abigail Allen2, Sheena Ranade2.

1 Medical Education, 2Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. PROLONGED OPIOID USE AFTER ORIF OF TIBIAL SHAFT FRACTURES. Zakaria Chakrani1, Husni Alasadi1, Brocha Stern2, Nicole Zubizarreta2, Jashvant Poeran2, David Forsh2. 1Medical Education, 2Orthopaedics.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. SINGLE-CELL ENTROPY SCORING DISCERNS TUMOR INITIATING CELL MARKERS IN NON-SMALL CELL LUNG CANCER. Daniel Charytonowicz1, Arpit Dave2, Kristin Beaumont2, Alexander Tsankov2, Robert Sebra2. 1Medical Education, 2Genetics and Genomic Sciences.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY.

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SCALP AND SERUM PROFILING OF FRONTAL FIBROSING ALOPECIA. Sumanth Chennareddy1, Celina Dubin2, Jacob Glickman2, Ester Del Duca2, Emma Guttman2. 1Medical Education, 2Dermatology.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY.

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MICROSIMULATION MODELING TO INVESTIGATE COST-EFFECTIVENESS OF SURGICAL TREATMENT FOR ISCHEMIC HEART FAILURE. Susmita Chennareddy1, Bart Ferket2. 1Medical Education, 2Population Health Science and Policy. 1,2Icahn School of Medicine at Mount Sinai, New York, NY.

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MATURATION OF TELEMEDICINE THROUGHOUT THE PANDEMIC: EXPERIENCES FROM PRIMARY CARE PRACTICES ACROSS THE US. Logan Cho1, Natalie Benda2, Samantha Serrano3, Katerina Andreadis4, Crispin Goytia3, Jenny J. Lin5, Carol Horowitz3, Jessica Ancker6, Jashvant Poeran3. 1Medical Education. 3,4Population Health Science and Policy, 5Medicine. 1,3,5Icahn School of Medicine at Mount Sinai, New York, NY, 2,4Weill Cornell Medical College, New York, NY, 6Vanderbilt University Medical Center, Nashville, TN. ECONOMIC ANALYSIS OF MRI AND PHYSICAL THERAPY REIMBURSEMENT IN ACL RECONSTRUCTION. Brennan Chu1, Justin Tiao2, Alexis Colvin2. 1Medical Education, 2Orthopaedics.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. PARENTAL EMPOWERMENT AND EFFICACY AMONG FOOD INSECURE FAMILIES AT A PEDIATRIC PRACTICE IN EAST HARLEM, NEW YORK CITY. Paige Cloonan1, Sonia Khurana1, Leora Mogilner2, Jennifer Acevedo2, Chris Gennings3, Shachi Mistry3, Stephanie Wu2, Eve Spear4, Arthi Vickneswaramoorthy2, Eden Alin5, Jenna Wisch6, Lauren Zajac2. 1Medical Education, 2,4,5,6Pediatrics, 3Population Health Science and Policy. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY, 4Barnard University, NY, NY, 5NYIT College of Osteopathic Medicine, Old Westbury, NY, 6Stanford University, Stanford, CA.

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ADDRESSING THE PSYCHOTROPIC MEDICATION SHORTAGE IN A LOW-INCOME COUNTRY. Janet Coleman-Belin1, Hannah Johnson2, Craig Katz3.1Medical Education, 3Psychiatry.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, NY. A PROPOSAL FOR SELECTING POTENTIALLY INAPPROPRIATE MEDICATIONS IN HOSPITALIZED ELDERLY TO ADDRESS IN ELECTRONIC HEALTH RECORD-BASED CROSSOVER RANDOMIZED CONTROLLED TRIAL. Yhan Colon Iban1, Mayuri Jain2, Rainier Soriano3, Jashvant Poeran2.

1 Medical Education, 2Population Health Science and Policy, 3Geriatrics and Palliative Medicine. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. EFFECT OF TRANSVERSUS ABDOMINAL PLANE BLOCK USING LIPOSOMAL BUPIVACAINE VERSUS STANDARD BUPIVACAINE FOR OPEN MYOMECTOMY: A PILOT RCT STUDY. Tyler D’Ovidio1, Matthew Sison2, Cynthia Mercedes2, Gabrielle Veilleux2, Jong Kim2, Andjela Pehar2, Daniel Katz2.1Medical Education, 2Anesthesiology.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. DISCOVERY OF A NOVEL, SELECTIVE AND POTENT EZH2 PROTEIN DEGRADER TO TARGET TRIPLE NEGATIVE BREAST CANCER. Brandon Dale1, Chris Anderson2, Kwang-Su Park2, H Ümit Kaniskan2, Xufen Yu2, Jian Jin2.1Medical Education, 2Pharmacology and Systems Therapeutics.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. CHARACTERIZING THE DISTINCT GENOMIC IMMUNE PROFILE OF VITILIGO IN LESIONAL AND NON-LESIONAL SKIN. Eden David1, Ester Del Duca2, Emma Guttman2. 1Medical Education, 2 Dermatology. 1,2Icahn School of Medicine at Mount Sinai, New York, NY.

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NON-INVASIVE MARKERS OF VENTRICULAR ARRHYTHMIA IN DEGENERATIVE MITRAL VALVE PROLAPSE. Navindra David1, Percy Boateng2, Ahmed El-Eshmawi2, David Adams2, Dimosthenis Pandis2. 1Medical Education, 2Cardiovascular Surgery.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. COCHLEAR IMPLANTS ON SOCIAL MEDIA: A NATURAL LANGUAGE PROCESSING ANALYSIS OF THE ONLINE PERSPECTIVE. Calista Dominy1, Evan Kominsky2, Eleni Varelas2, Joshua Rosenberg2, Alfred Iloreta2, Aldo Londino2. 1Medical Education, 2Otolaryngology.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. PREVALENCE AND CLINICAL CONSEQUENCES OF GENETIC VARIANTS ASSOCIATED WITH FAMILIAL HYPERCHOLESTEROLEMIA AND LDL-C LOWERING IN A DIVERSE PATIENT POPULATION. Bethany Dubois1, Emily Soper2, Michael Turchin2, Gillian Belbin2, Eimear Kenny2, Noura Abul-Husn2. 1Medical Education, 2Genetics and Genomic Sciences.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. NF2 MUTATION ASSOCIATED WITH ACCELERATED TIME TO RECURRENCE FOR OLDER PATIENTS WITH ATYPICAL MENINGIOMAS. Jonathan Dullea1, Danielle Chaluts2, Jack Rutland2, Corey Gill2, Vikram Vasan2, Yayoi Kinoshita3, Russell McBride3, Joshua Bederson2, Michael Donovan3, Robert Sebra4, Melissa Umphlett3, Raj Shrivastava2.

1 Medical Education, 2Neurosurgery, 3Pathology, 4Genetics and Genomic Sciences. 1,2,3,4Icahn School of Medicine at Mount Sinai, New York, NY. ANTI-INTEGRIN ɑVβ6 ANTIBODIES IN PATIENTS WITH IBD. Alexandra Dunn1, Jeremy Fischer1, Carmen Argmann2, Mayte Suarez-Farinas2, Alexandra Livanos3, Saurabh Mehandru3. 1Medical Education, 2Genetics and Genomic Sciences, 3Medicine. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY.

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DISPARITIES IN MATERNAL HEALTH OUTCOMES FOLLOWING CHILDBIRTH IN NEW YORK CITY: AN EQUITY ANALYSIS. Annalise Eger1, Toni Stern2. 1Medical Education, 2Obstetrics, Gynecology, and Reproductive Science. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. ASSOCIATIONS AMONG PRENATAL EXPOSURE TO METALS AND THEIR MIXTURE AND INFANT NEGATIVE AFFECTIVITY: EXPLORING EFFECT MODIFICATION BY PRENATAL CORTISOL AND FETAL SEX. Samuel Eitenbichler1, Francheska Merced-Nieves2, Rosalind Wright2. 1Medical Education, 2Pediatrics. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. POPULATION-BASED PENETRANCE OF DELETERIOUS CLINICAL VARIANTS. Iain Forrest1, Kumardeep Chaudhary2, Ha My Vy2, Ben Petrazzini2, Shantanu Bafna2, Daniel Jordan2, Ghislain Rocheleau2, Ruth Loos2, Girish Nadkarni3, Judy Cho3, Ron Do2.1Medical Education, 2Genetics and Genomic Sciences, 3Medicine.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, NY. CLINICAL AND DEMOGRAPHIC CHARACTERISTICS OF PATIENTS WITH COVID-19 BREAKTHROUGH INFECTIONS IN NEW YORK CITY. Miriam Frisch1, Gabriel Cohen2, Angelie Oberoi3, Leopolda Silvera3, Justin Chan3, Vikramjit Mukherjee3, Kenra Ford3, Joseph Masci7. 1Medical Education, 2,7Medicine. 1,7Icahn School of Medicine at Mount Sinai, New York, NY, 2Bellevue Hospital, NYC H+H, NY, 3NYC H+H. INTRAVENOUS STEROIDS ARE NOT ASSOCIATED WITH BETTER OUTCOMES IN PATIENTS WITH CROHN’S DISEASE HOSPITALIZED FOR AN ACUTE BOWEL OBSTRUCTION. Mariely Garcia1, Jean-Frédéric Colombel2, Anketse Debebe3, Farhan Mahmood4, Sharon Nirenberg3, Alexa Rendon3, Jiani Xiang4, David Sachar2.1Medical Education, 2Medicine, 3Genetics and Genomic Sciences.

1,2,3,4 Icahn School of Medicine at Mount Sinai, New York, NY.

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MEDICAL STUDENT COMPREHENSION AND APPLICABILITY OF ADVERSE CHILDHOOD EXPERIENCES TRAINING. Jennifer Gates1, Tomas Restrepo Palacio2, Kyle Gibson1, Arifa Zaidi3, Susan Kim4, Timothy Rice2.1Medical Education, 2Psychiatry. 1 ,2 Icahn School of Medicine at Mount Sinai, 3New York University, 1,2,3 New York, NY, 4 Massachusetts General Hospital, Boston, MA. A COMMUNITY-ACADEMIC PARTNERSHIP TO CREATE AN ONSITE FOOD PANTRY IN A PEDIATRIC CLINIC TO ADDRESS FOOD INSECURITY IN THE ERA OF COVID-19.

Alioune Gaye1, Lauren Zajac2. 1Medical Education, 2 Environmental Medicine & Public Health. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. THE ASSOCIATION BETWEEN UV-RELATED DERMATOLOGICAL CARCINOMAS AND EXFOLIATION SYNDROME AND EXFOLIATION GLAUCOMA: A CLINIC-BASED STUDY. Jack Geduldig1, Jeff Huang2, Louis Pasquale2. 1Medical Education, 2 Ophthalmology. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. THE EXPERIENCES OF ASYLUM SEEKERS TO THE UNITED STATES DURING THE COVID-19 PANDEMIC. Mahalya Gogerly-Moragoda1, Kevin Molyneux2, Dustin Kee1, Kim Baranowski3, Elizabeth Singer2.1Medical Education, 2Emergency Medicine, 3Psychiatry.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, NY. GENERATING NOVEL ENDOCRINE DATASETS FROM OPEN SOURCE DATA AND ANATOMICAL PRIORS. Rachel Gologorsky1, Edward Harake2, Grace von Oiste3, Mustafa Nasir-Moin4, William Couldwell5, Todd Hollon6, Eric Oermann4. 1Medical Education. 4,5,6Neurosurgery. 1Icahn School of Medicine at Mount Sinai, New York, NY, 2University of Michigan Medical School, Ann Arbor, MI, 3Harvard University, Cambridge, MA, 4New York University Langone Medical Center, New York, NY, 5University of Utah, Salt Lake City, UT, 6University of Michigan, Ann Arbor, MI.

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ORAL MICROBIOME COMPOSITION OF PEANUT ALLERGIC CHILDREN WITH LOW VERSUS HIGH SENSITIZATION TO PEANUT. Miguel Gomez1, Yoojin Chun2, Hsi-en Ho2, Supinda Bunyavanich2.

1 Medical Education, 2Pediatrics. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. A SYSTEMATIC REVIEW OF DIGITAL INTERVENTIONS TO IMPROVE ART ADHERENCE AMONG YOUTH LIVING WITH HIV IN SUB-SAHARAN AFRICA. Kevin Griffee1, Roxanne Martin2, Ashley Chory2, Rachel Vreeman2.

1 Medical Education, 2Arnhold Institute for Global Health.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. OUTCOMES IN INFANTS BORN TO MOTHERS WITH AND WITHOUT NON-ALCOHOLIC FATTY LIVER DISEASE. Aliza Gross1, Rhoda Sperling2, Courtney Juliano3, Jaime Chu3, John Bucuvalas3, Tatyana Kushner4. 1Medical Education, 2Obstetrics, Gynecology, and Reproductive Science, 3Pediatrics, 4Medicine. 1,2,3,4Icahn School of Medicine at Mount Sinai, New York, NY. MIDTERM FUNCTIONAL AND PATIENT-REPORTED OUTCOMES IN SHOULDER ARTHROPLASTY PATIENTS OVER THE AGE OF 75.

Benjamin Gross1, Jordan Bernstein2, Carl Cirino2, Christopher White1, Akshar Patel2, Bradford Parsons2, Evan Flatow2, Paul Cagle2. 1Medical Education, 2Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. PANCREATIC NEURAL CIRCUITRY IN OBESITY AND DIABETES. Rollie Hampton1, Alexandra Alvarsson2, Maria Jimenez2, Rosemary Li2, Kavya Devarakonda2, Sarah Stanley2. 1Medical Education, 2Neuroscience.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY.

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A QUALITATIVE STUDY OF PATIENT PERCEPTION AFTER COMPLETING A CLINICAL RESEARCH STUDY. Celestine He1, Bridget Mueller2, Gina Lee2, Gabriela Cedillo2, Alyha Benitez2, Shanna-kay Griffiths2, Jessica Robinson-Papp2, Mary Catherine George2. 1Medical Education, 2Neurology. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. DEVELOPMENT OF A MACHINE LEARNING MODEL TO IDENTIFY ELBOW IMPLANTS FROM RADIOGRAPHIC IMAGES. Philip Henson1, Nima Assad1, Brian Cho1, John Schwartz1, Eric Geng1, Varun Arvind1, Samuel Cho2, Jun Kim2. 1Medical Education, 2Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. RESILIENCE FACTORS AND COPING STRATEGIES AMONG MEDICAL STUDENTS DURING THE COVID-19 PANDEMIC: AN EXPLORATORY STUDY. Josimar Hernandez Antonio1, Ezequiel Ramos1, Jordyn Feingold2, Vedika Kumar3, Emma Stanislawski4, Alicia Hurtado1, Ksenia Gorbenko5, Craig Katz1.1Medical Education, 2,3,4Psychiatry, 5Population Health Science and Policy.

1,2,5 Icahn School of Medicine at Mount Sinai, New York, NY, 3Zucker Hillside Hospital, 4 Maine Medical Center.

TOTAL JOINT ARTHROPLASTY COSTS ASSOCIATED WITH MEANINGFUL IMPROVEMENTS IN COMORBIDITY SUBGROUPS. Michael Herrera1, Sara Kiani2, Nicholas Pitaro2, Jashvant Poeran3, Brett Hayden3, Darwin Chen3, Calin Moucha3. 1Medical Education, 2Global Health.

3 Orthopaedics. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. EVALUATING THE IMPACT OF COMPREHENSIVE MALARIA EDUCATION ON THE USE OF LONG-LASTING INSECTICIDAL NETS IN JINJA, UGANDA. Skylar Hess1, Olivia Oberkircher1, Xueying Zhang2, Jessie Stone3, Nils Hennig4.

1 Medical Education. 4Pediatrics. 1,2,4Icahn School of Medicine at Mount Sinai, New York, NY, 3Soft Power Health, Kyabirwa, Uganda.

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ADHD BASELINE IMPACT SCORES AND THE EFFECT OF STIMULANTS ON COMPOSITE SCORES. Eugene Hrabarchuk1, Theodore Hannah2, Adam Li2, Alexander Schupper2, Lily McCarthy2, Muhammad Ali2, Roshini Kalagara2, Alex Gometz3, Mark Lovell4, Tanvir Choudhri2. 1Medical Education, 2,4Neurosurgery, 3Rehabilitation Medicine.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY, 3Physical Medicine and Rehabilitation, Concussion Management of New York, 4University of Pittsburgh Medical Center.

CORRELATES OF PATIENT-REPORTED HEALTH MEASURES IN PATIENTS WITH MULTIVESSEL CORONARY ARTERY DISEASE UNDERGOING PERCUTANEOUS CORONARY ARTERY INTERVENTION. Suvruta Iruvanti1, Amit Blumfield2, Clayton Snyder3, Gurpreet Johal3, Samantha Sartori3, Birgit Vogel3, Gennaro Giustino3, Htoo Kyaw3, George Dangas3, Roxana Mehran3, Annapoorna Kini3, Samin Sharma3, Serdar Farhan3. 1Medical Education, 3Medicine. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. CORONARY ARTERY CTA PRIOR TO CARDIOVASCULAR SURGERY: A RELIABLE, LESS INVASIVE ALTERNATIVE TO CATHETERIZATION FOR ROUTINE PREOPERATIVE SCREENING. Yonatan Israel1, Percy Boateng2, Ahmed El-Eshmawi2, David Adams2, Dimosthenis Pandis2.1Medical Education, 2Cardiovascular Surgery.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. AUTOMATED DETERMINATION OF LEFT VENTRICULAR FUNCTION USING ELECTROCARDIOGRAM DATA IN PATIENTS ON MAINTENANCE HEMODIALYSIS. Joy Jiang1, Akhil Vaid2, Ashwin Sawant3, Patricia Kovatch2, Alexander Charney2, Benjamin Glicksberg2, Lili Chan3, Girish Nadkarni3.1Medical Education, 2Genetics and Genomic Sciences, 3Medicine. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. LONGITUDINAL CHANGES IN ATTENTION AND MEMORY IN PREGNANT AND POSTPARTUM WOMEN. Matina Kakalis1, Emma Smith2, Vignesh Rajasekaran2, Katherine Samonek3, Lindsay Jamieson3, Kellyn Kuczarski3, Lotje de Witte2, Daniel Katz4, Kelly McMeen2, Harold Koenigsberg2, Erin Hazlett2, Antonia New2, Robert Pietrzak5, Margaret McClure6, M. Mercedes Perez-Rodriguez2. 1Medical Education, 2,5,6Psychiatry, 4Obstetrics, Gynecology, and Reproductive Science. 1,2,4Icahn School of Medicine at Mount Sinai, New York, NY, 3,6Fairfield University, Fairfield, CT, 5Yale University, New Haven, CT.

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66

PORTABLE STROKE DETECTION IN A COMPREHENSIVE STROKE CENTER: PILOT DEPLOYMENT OF THE CEREBROTECH VISOR. Roshini Kalagara1, Susmita Chennareddy2, Colton Smith2, Stavros Matsoukas2, Abhiraj Bhimani2, Christopher Kellner2. 1Medical Education, 2Neurosurgery.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. LIVING WITH HEPATITIS C AFTER INCARCERATION: A QUALITATIVE STUDY OF FORMER OFFENDERS’ EXPERIENCES. Samir Kamat1, Shumayl Syed1, Sankeerth Kondapalli2, Ksenia Gorbenko3, Joel Cantor4, Aakash Shah5, Matthew Akiyama6. 1,2Medical Education, 3Population Health Science and Policy, 5Emergency Medicine, 6Medicine. 1,3Icahn School of Medicine at Mount Sinai, New York, NY, 2Rutgers New Jersey Medical School, Newark, NJ, 4Rutgers University, 5Hackensack Meridian School of Medicine, 6 Albert Einstein College of Medicine.

THE PSYCHOLOGICAL CONSEQUENCES OF THE COVID-19 PANDEMIC ON GRADUATE MEDICAL TRAINEES: A LONGITUDINAL ANALYSIS OF FACTORS CONTRIBUTING TO PROLONGED BURNOUT. Carly Kaplan1, Jonathan Ripp1, Saadia Akhtar2. 1Medical Education, 2 Emergency Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. TCR SEQUENCING REVEALS HETEROGENOUS EFFECTS OF T CELL DEPLETION ON DONOR-REACTIVE T CELLS IN KIDNEY TRANSPLANT RECIPIENTS. Calla Khilnani1, Pamela Cruz-Encarnación2, Mehek Ningoo2, Miguel Fribourg-Casajuana3, Paolo Cravedi3, Peter Heeger3.1Medical Education, 3Medicine. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. FINANCIAL WORRY AND FOOD INSECURITY AT A PEDIATRIC CLINIC IN EAST HARLEM, NEW YORK CITY. Sonia Khurana1, Paige Cloonan1, Lauren Zajac2, Jennifer Acevedo3, Jenna Wisch2, Chris Gennings4, Shachi Mistry4, Arthi Vickneswaramoorthy2, Eve Spear2, Eden Alin2, Stephanie Wu2, Leora Mogilner2. 1Medical Education, 2Pediatrics, 3 Pediatric Environmental Health, 4Population Health Science and Policy. 1,2,3,4Icahn School of Medicine at Mount Sinai, New York, NY. THE UNTOLD STORY OF SCHLOENDORFF. Zainab Kiyam1, Jacob Appel2.1Medical Education, 2Psychiatry.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY.

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EARLY POUCHITIS IS ASSOCIATED WITH LATER CROHN’S DISEASE-LIKE POUCH INFLAMMATION. David Kohler1, Michael Plietz2, Sergey Khaitov2, Patricia Sylla2, Alexander Greenstein2, Marla Dubinsky3, Maia Kayal3.1Medical Education, 2Surgery, 3Medicine.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, NY. MAKING THE CASE FOR PARKS AS A CRITICAL PART OF PUBLIC HEALTH PREPAREDNESS IN THE AGE OF COVID-19.

Niathi Kona1, Kathleen McGovern2, Andrea Deierlein3, Susan Teitelbaum2, Mary Wolff2, Maida Galvez2.1Medical Education, 2Environmental Medicine & Public Health.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY, 3 NYU School of Global Public Health, New York, NY. LEVERAGING AN INFORMATION EXTRACTION PIPELINE IN THE ANALYSIS OF VIRTUAL E-CONSULTS. Anish Kumar, 1 Ann-Gel Palermo1. 1Medical Education.

1 Icahn School of Medicine at Mount Sinai, New York, NY. IMPACT OF IMMUNOMODULATORY TREATMENTS ON SARS-COV-2 ANTIBODY RESPONSES IN ATOPIC DERMATITIS PATIENTS. Leore Lavin1, Benjamin ungar2, Ana Pavel2, Emma Guttman2.

1 Medical Education, 2Dermatology. 1,2Icahn School of Medicine at Mount Sinai, New York, NY.

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APPROACHES TO DEFINING THE MECHANISMS OF PERIANAL FISTULA INCEPTION IN AFRICAN AND EUROPEAN ANCESTRY CROHN’S DISEASE PATIENTS. Rachel Levantovsky1, Christopher Tastad2, Shikha Nayar2, Nai-Yun Hsu2, Ling-Shiang (Felix) Chuang3, Judy Cho3. 1Medical Education, 2Medicine, 3Genetics and Genomic Sciences. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. PATIENTS AWARENESS OF FACTS AND MYTHS ASSOCIATED WITH DIETARY INTAKE AND KIDNEY STONES. Micah Levy1, Chih Peng Chin2, Evan Garden2, Krishna Ravivarapu2, Osama Al-Alao2, Joseph Sewell Araya2, Caner Dinlenc2, Michael Palese2.

1 Medical Education, 2Urology. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. TYPE I INTERFERON MODULATES LANGERHANS CELL ADAM17 TO PROMOTE PHOTOSENSITIVITY IN LUPUS. Thomas Li1, Keila Veiga2, Noa Schwartz2, Yurii Chinenov2, David Oliver2, Jose Lora2, Ali Jabbari3, Yong Liu4, William Shipman2, Marvin Sandoval2, Isabel Sollohub2, William Ambler2, Bikash Mishra2, Lionel Ivashkiv2, Mehdi Rashighi5, James Krueger3, Niroshana Anandasabapathy4, Carl Blobel2, Theresa Lu2. 1Medical Education. 1Icahn School of Medicine at Mount Sinai, 2Hospital for Special Surgery, 3Rockefeller University, 4Weill Cornell Medical College, New York, NY. 5University of Massachusetts Medical School, Worcester, MA. PREVALENCE OF GERMLINE CLONAL HEMATOPOIESIS OF INDETERMINANT POTENTIAL (CHIP) MUTATIONS IN INDIVIDUALS WHO DEVELOP HEMATOLOGICAL MALIGNANCIES. Matthew Liebers1, Alessandro Lagana2, 1Medical Education, 2 Hematology/Oncology. 1,2Icahn School of Medicine at Mount Sinai, New York, NY.

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GENERATION OF IPSC MODELS FOR RASOPATHY INDUCED CARDIAC PATHOLOGIES. Clifford Liu1, Nelson Rodriguez2, Simon Ng2, Bruce Gelb2. 1Medical Education, 2 Pediatrics. 1,2Icahn School of Medicine at Mount Sinai, New York, NY.

77

VISUAL DEFICITS IN CRANIOSYNOSTOSIS: GEOMETRIC MORPHOMETRIC ANALYSIS OF VISUAL STRUCTURES. Helen Liu1, Abigail Katz1, Peter Taub2. 1Medical Education, 2Surgery.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY.

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CLINICAL DECISION MAKING FOR PIGMENTED SKIN LESIONS: A COMPARISON BETWEEN DERMOSCOPY AND ELECTRICALIMPEDENCE SPECTROSCOPY ACROSS DIFFERENT LEVELS OF TRAINING. Isabel Lopera1, Shayan Owji2, Jonathan Ungar2, Benjamin Ungar2.

1 Medical Education, 2Dermatology. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. TRANSITION OF CARE IN CONGENITAL HEART DISEASE: A SINGLE CENTER EXPERIENCE AT A LARGE URBAN TERTIARY CARE SETTING. Christine Lopez1, Brittany Glassberg 2, Alexandra Dembar3, Maria Riasat3, Ali Zaidi4.

1 Medical Education, 3,4Medicine. 1,3,4Icahn School of Medicine at Mount Sinai, New York, NY, 2Perelman School of Medicine, Philadelphia, PA. CHARACTERIZING NON-RESPONDERS TO AN HIV DISCLOSURE INTERVENTION FOR CAREGIVERS OF CHILDREN WITH HIV: A POST-HOC ANALYSIS OF A CLUSTER RANDOMIZED TRIAL IN ELDORET, KENYA. Liza Magill1, Aaron Baum2, Rachel Vreeman2. 1Medical Education. 1Icahn School of Medicine at Mount Sinai, 2Arnhold Institute for Global Health, New York, NY.

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PARENTAL HESITANCY: TO VACCINATE OR NOT TO VACCINATE CHILDREN AGAINST SARS-COV-2, A SYSTEMATIC REVIEW. Simran Malhotra1, Kevin Griffee1, Roxanne Martin2, Ashley Chory2, Rachel Vreeman2.

1 Medical Education. 1Icahn School of Medicine at Mount Sinai, 2Arnhold Institute for Global Health, New York, NY. BREAKING OF IMMUNE TOLERANCE IN DOWN SYNDROME: A TRIAD OF CYTOKINES, ACTIVATED T CELLS, AND EXTRAFOLLICULAR B CELLS. Louise Malle1, Roosheel S. Patel2, Sofija Buta2, Ashley Richardson2, Vanessa Barcessat3, Justin Taft2, Paul Bastard4, Julie Samuels5, Rebecca Trachtman5, Jean-Laurent Casanova6, Luigi Notarangelo7, Sacha Gnjatic3, Douglas Bush5, Dusan Bogunovic2.

1 Medical Education, 2Microbiology, 5Pediatrics. 1,2,3,5Icahn School of Medicine at Mount Sinai, New York, NY, 4INSERM, 6Rockefeller University, 7NIAID, NIH. EFFECTS OF A HISTORY OF HEADACHE AND MIGRAINE TREATMENT ON BASELINE NEUROCOGNITIVE FUNCTION IN YOUNG ATHLETES. Lily McCarthy1, Theodore Hannah2, Adam Li2, Alexander Schupper2, Eugene Hrabarchuk2, Roshini Kalagara2, Muhammad Ali2, Alex Gometz3, Mark Lovell4, Tanvir Choudhri2. 1Medical Education, 2Neurosurgery, 4Neurology.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY, 3Concussion Management of New York, 4University of Pittsburgh, Pittsburgh, PA. THE DEVELOPMENT OF AN RT-PCR ASSAY AND A NEWCASTLE DISEASE VIRUS (NDV) REPORTER VIRUS FOR USE IN PHASE 1 CLINICAL TRIALS EVALUATING NDV-VECTORED VACCINES AGAINST COVID-19.

Stephen McCroskery1, Irene González-Domínguez2, Nicholas Lemus2, Peter Palese2, Weina Sun2. 1Medical Education, 2Microbiology. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. DEVELOPING A DECISION SUPPORT TOOL TO DETERMINE THE OPTIMAL NUMBER OF BANKED EMBRYOS TO ACHIEVE DESIRED FAMILY SIZE. Zahava Michaelson1, Devora Aharon2, Alan Copperman2.

1 Medical Education, 2Obstetrics, Gynecology, and Reproductive Science.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY.

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CULTURAL DIMENSIONS OF LONG-TERM HEALTH IMPACTS OF WORLD TRADE CENTER ENVIRONMENTAL EXPOSURES: A DISCOURSE ANALYSIS OF CONGRESSIONAL TESTIMONY. Alli Morgan1, Jacob Appel2.1Medical Education, 2Psychiatry.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. THE EFFICACY OF NETARSUDIL - POST APPROVAL REALITY. Oluwafeyikemi Okome1, Jane Song2, Jun Lin3, Sze Wong4. 1Medical Education, 2,3,4 Ophthalmology. 1,3Icahn School of Medicine at Mount Sinai, New York, NY, 2CareMount Medical, Mount Kisco, NY, 4New York Eye and Ear Infirmary of Mount Sinai, New York, NY. HEALTHCARE UTILIZATION AND SPENDING AMONG HOMEBOUND OLDER ADULTS, 2011-17.

Benjamin Oseroff1, Claire Ankuda2, Evan Bollens-Lund2, Melissa Garrido3, Katherine Ornstein2. 1Medical Education, 2Geriatrics and Palliative Medicine.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY, 3 Boston University School of Public Health, Boston, MA. IMMUNOTHERAPY EFFECTIVENESS IN STAGE IV NON-SMALL CELL LUNG CANCER ACCORDING TO PERSONAL AND CLINICAL CHARACTERISTICS. Krishna Patel1, Naomi Alpert2, Emanuela Taioli2. 1Medical Education, 2 Population Health Science and Policy. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. ADDED RISK FOR ALZHEIMER’S DISEASE? INVESTIGATING ALTERNATIVE SPLICING FROM A NOVEL DELETION IN NEUREXIN-1.

Adriana Pero1, Michael Fernando2, Kristen Brennand2. 1Medical Education, 2 Neuroscience. 1,2Icahn School of Medicine at Mount Sinai, New York, NY.

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EVALUATING THE OUTCOMES OF A PSYCHIATRY IN THE CREATIVE ARTS COURSE. Charlotte Pierce1, Timothy Rice2, Jacob Appel2.1Medical Education, 2 Psychiatry. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. EVALUATING RESOURCE UTILIZATION FOR IN-PERSON AND VIRTUAL JOINT CLASSES IN TOTAL JOINT ARTHROPLASTY: AN ANALYSIS OF ATTENDANCE PATTERNS AT A LARGE METROPOLITAN HEALTH SYSTEM. Nicholas Pitaro1, Joseph Barbera2, William Ranson2, Nicole Zubizarreta2, Darwin Chen2, Calin Moucha2, Brett Hayden2, Jashvant Poeran2. 1Medical Education, 2Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. ALTERED MICROGLIAL GENOME STRUCTURE AND TRANSCRIPTION IN HIV ENCEPHALITIS IMPACT HIV INTEGRATION. Amara Plaza-Jennings1, Brandon Pratt2, Benjamin Chen3, Lotje de Witte4, Susan Morgello5, Hyejung Won2, Schahram Akbarian4.

1 Medical Education, 2Neuroscience, 3Medicine, 4Psychiatry, 5Neurology.

1,3,4,5 Icahn School of Medicine at Mount Sinai, New York, NY, 2 University of North Carolina School of Medicine, Chapel Hill, NC. TRUST BUT VERIFY: DISCORDANCE IN OPIOID REPORTING BETWEEN THE ELECTRONIC MEDICAL RECORD AND A STATEWIDE DATABASE. Amit Pujari1, David Forsh2. 1Medical Education, 2Orthopaedics.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. LONGITUDINAL FUNCTIONAL MRI DEMONSTRATES TRANSLOCATION OF LANGUAGE FUNCTION IN PATIENTS WITH BRAIN TUMORS. Addison Quinones1, Mehrnaz Jenabi2, Luca Pasquini2, Kyung Peck3, Nelson Moss4, Cameron Brennan4, Viviane Tabar4, Andrei Holodny2. 1Medical Education, 2Radiology, 4Neurosurgery. 1Icahn School of Medicine at Mount Sinai, New York, NY, 2,3,4Memorial Sloan Kettering Cancer Center New York, NY.

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INVESTIGATING PCDH7-EFNB3 INTERACTION IN HEPATIC STELLATE CELLS. Vignesh Rajasekaran1, James Carter2, Scott Friedman2. 1Medical Education, 2 Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. ASSESSING NYC MEDICAL STUDENTS REACTIONS’ DURING INITIAL SIX MONTHS OF COVID 19 PANDEMIC: A QUALITATIVE STUDY. Ezequiel Ramos1, Josimar Hernandez Antonio1, Jordyn Feingold2, Vedika Kumar3, Emma Stanislawski4, Alicia Hurtado2, Ksenia Gorbenko5. 1Medical Education, 2,3,4Psychiatry, 5Population Health Science and Policy. 1,2,5Icahn School of Medicine at Mount Sinai, New York, NY, 3Zucker Hillside Hospital, New York, NY, 4 Maine Medical Center, Portland, ME. PRIMARY SPOKEN LANGUAGE AND VARIANCES IN USE OF REGIONAL ANESTHESIA IN TOTAL JOINT ARTHROPLASTY FOR OLDER ADULTS. Hayley Raymond1, Husni Alasadi1, Nicole Zubizarreta2, Samuel DeMaria3, Calin Moucha2, Jashvant Poeran2. 1Medical Education, 2Orthopaedics, 3 Anesthesiology. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. LONG TERM NEUROLOGICAL IMPAIRMENTS OF MILD AND LONG HAUL COVID-19 INFECTION IMPEDE ACTIVITIES OF DAILY LIVING AND MENTAL HEALTH: USING NARRATIVE MEDICINE TO UNDERSTAND COVID-19 FROM THE PATIENT PERSPECTIVE. Emma Reford1, Nicki Mohammadi2, Natalia Romano Spica2, Christopher Kellner2.

1 Medical Education, 2Neurosurgery. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. ENABLING MORE INCLUSIVE HEALTHCARE: FOUR MARKET APPROACHES TO LGBTQ+ DIGITAL HEALTH. Jen Ren1, Adriana Krasniansky2, Ann-Gel Palermo1. 1Medical Education.

1 Icahn School of Medicine at Mount Sinai, New York, NY, 2Rock Health.

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103 104

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SURVEY-BASED STUDY TO UNDERSTAND HS PATIENT EXPERIENCES AND PERCEPTIONS ABOUT I&D PROCEDURES. Rishab Revankar1, Howa Yeung2, Heather Holahan3, Priyanka Vedak4, Franklin Blum3, Christopher Sayed3. 1Medical Education, 2,3,4Dermatology. 1Icahn School of Medicine at Mount Sinai, New York, NY, 2Emory University School of Medicine, Atlanta, GA, 3UNC Chapel Hill School of Medicine, Chapel Hill, NC, 4UNC Chapel Hill School of Medicine, Chapel Hill, NC. DEMOGRAPHIC CHARACTERISTICS OF ASYLUM-SEEKERS WHO ENTERED VIA THE US-MEXICO BORDER AND PRESENTED TO A NYC CENTER FOR SURVIVORS OF TORTURE. Jeanette Rios1, Dinali Fernando2, Ben McVane2. 1Medical Education, 2 Emergency Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. IMPROVING END OF LIFE FOR OLDER ADULTS WITH FUNCTIONAL DISABILITY. Lukas Ritzer1, Claire Ankuda2. 1Medical Education, 2Geriatrics and Palliative Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. RACIAL DISPARITIES IN CAREGIVER SUPPORT AMONG ADULT CHILDREN CARING FOR AGING PARENTS. Harley Roberts1, Katherine Ornstein2, Evan Bollens-Lund2, Amy Kelley2.

1 Medical Education, 2Geriatrics and Palliative Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. EFFECT OF SURGICAL RESECTION ON QUALITY OF LIFE IN PATIENTS WITH CARCINOID SYNDROME: A PROSPECTIVE ANALYSIS. Andrew Rosowicz1, James Johnson2, Laura Olson2, Venu Bangla2, Edward Wolin3, Michelle Kim3, Celia Divino2. 1Medical Education, 2Surgery, 3Medicine.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, NY.

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LONGITUDINAL EVALUATION OF CARDIAC FUNCTION AND STRUCTURE IN APOE NULL AND C57BL/6J MICE AFTER GAMMA AND SPACE-TYPE RADIATION EXPOSURE. Nathaniel Saffran1, Agnieszka Brojakowska2, Kenneth Fish2, Virginia Gillespie2, Lahouaria Hadri2, David Goukassian2. 1Medical Education, 2Medicine.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY.

107

RE-EVALUATING THE NEED FOR ROUTINE PREOPERATIVE TYPE AND SCREEN IN ROBOTIC PROSTATECTOMIES. Jay Sanghvi1, Garrett Burnett2, James Maher2. 1Medical Education, 2 Anesthesiology. 1,2Icahn School of Medicine at Mount Sinai, New York, NY.

108

PRIMARY CARE ENGAGEMENT AND ASSOCIATED RISK FACTORS FOR PEOPLE WHO USE DRUGS AND/OR ALCOHOL. Remington Schneider1, Jeffrey Weiss2, Linda Wang3. 1Medical Education, 2,3 Medicine. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY.

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THE IMPACT OF PRIOR ARTHROSCOPY ON OUTCOMES FOLLOWING UNICONDYLAR KNEE ARTHROPLASTY: A NATIONAL MEDICARE DATA ANALYSIS. Kush Shah1, Jashvant Poeran2, Hsin-Hui Huang2, Darwin Chen2, Brett Hayden2, Calin Moucha2. 1Medical Education, 2Orthopaedics.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BUPRENORPHINE TREATMENT DURING COVID-19 IN A HARM REDUCTION PRIMARY CARE SETTING. Jacob Sherman1, Remington Schneider2, Jeffrey Weiss3, Linda Wang4.

1 Medical Education, 3,4Medicine. 1,2,4Icahn School of Medicine at Mount Sinai, New York, NY.

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PREDICTION OF LIVER DISEASE OUTCOME USING MR ELASTOGRAPHY. Joo Yeon Shin1, Ghadi Abboud2, Paul Kennedy2, Bachir Taouli2.

1 Medical Education, 2Radiology. 1Icahn School of Medicine at Mount Sinai, New York, NY, 2Translational and Molecular Imaging Institute, New York, NY. EVALUATION OF PROGRAM TO IMPLEMENT HIV PREP SERVICES FOR WOMEN AT GYNECOLOGIC SERVICES. Francesca Silvestri1, Natalie Alvarez2, Omara Afzal2, Mary Siobhan Dolan2, Antonio Urbina3, Andres Ramirez Zamudio2.1Medical Education, 2 Obstetrics, Gynecology, and Reproductive Science, 3Medicine.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, NY.

113

ASSESSMENT OF TELEMEDICINE-ENHANCED COMMUNITY PARAMEDICINE INTERVENTION AT A LARGE ACADEMIC MEDICAL CENTER. Zay Smolar1, Kevin Munjal2. 1Medical Education, 2Emergency Medicine.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY.

114

PREDICTORS OF POSTPARTUM DEPRESSION AMONG HISPANIC WOMEN DURING THE COVID-19 PANDEMIC. Daniela Suarez-Rebling1, Anna Rommel2. 1Medical Education, 2 Psychiatry. 1,2Icahn School of Medicine at Mount Sinai, New York, NY.

115

COMPARING VNS AND RESECTIVE SURGERY OUTCOMES IN PATIENTS WITH CO-OCCURRING AUTISM AND EPILEPSY TO PATIENTS WITH EPILEPSY ALONE: A POPULATION-BASED STUDY. Varun Subramaniam1, Churl-Su Kwon2. 1Medical Education, 2Neurosurgery.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY.

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ANTI-TUMOR EFFECTS OF VERTEPORFIN AND PHOTODYNAMIC THERAPY IN COMBINATION WITH STANDARD OF CARE ON PATIENT-DERIVED GBM CELL LINES. Sweta Sudhir1, Maria Anastasiadou2, Constantinos Hadjipanayis2.

1 Medical Education, 2Neurosurgery. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. PSYCHOLOGICAL RESILIENCE IN FRONTLINE HEALTHCARE WORKERS DURING THE ACUTE PHASE OF THE COVID-19 PANDEMIC IN NEW YORK CITY. Shumayl Syed1, Robert Pietrzak2, Jordyn Feingold3, Adriana Feder3, Dennis Charney3, Lauren Peccoralo4, Steven Southwick2, Jonathan Ripp4.

1 Medical Education, 2,3Psychiatry, 4Medicine. 1,3,4Icahn School of Medicine at Mount Sinai, New York, NY, 2Yale University, New Haven, CT. SPINE VS. HAND SURGEONS: A SENTIMENT ANALYSIS DRIVEN COMPARISON STUDY OF ORTHOPEDIC SURGEON ONLINE REVIEWS. Justin Tang1, Varun Arvind1, Jun Kim2, Samuel Cho2. 1Medical Education, 2Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. DETERMINING TRENDS IN PROCEDURE COST, TOTAL HEALTHCARE UTILIZATION, AND DIRECT PAYMENTS MADE BY PATIENTS FOR PRIMARY ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION BETWEEN 2013 AND 2017.

Justin Tiao1, Brennan Chu1, Alexis Colvin2. 1Medical Education, 2Orthopaedics.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. TWO-CENTER STUDY OF A VIRTUAL, SIMULATION-BASED LAPAROSCOPIC TRAINING CURRICULUM IN MEXICO. Rachel Todd1, Zerubabbel Asfaw2, Maria Marcela Bailez3, Jacqueline Narvaez4, Linda Zhang5. 1Medical Education, 3,5Surgery. 1,2,5Icahn School of Medicine at Mount Sinai, New York, NY, 3JP Garrahan Pediatric Hospital, Buenos Aires, Argentina, 4 Society of American Gastrointestinal and Endoscopic Surgeons Los Angeles, CA.

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ASSOCIATIONS BETWEEN PRENATAL PARTICULATE AIR POLLUTION AND INFANT LUNG FUNCTION. Serena Tolani1, Whitney Cowell2, Maritza Minchala3, Brent Coull4, Rosalind Wright3, Alison Lee2. 1Medical Education, 2,3Pediatrics. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY, 4Harvard T.H. Chan School of Public Health, Boston MA. IN-HOSPITAL OUTCOMES IN PATIENTS WITH AND WITHOUT EPILEPSY DIAGNOSED WITH COVID-19.

Claire Ufongene1, Jung-Yi Lin2, Grace Van Hyfte2, Jonathan goldstein2, Brian Mathew2, Allison Navis2, Louise McCarthy2, Leah Blank2, Ariella Cohen2, Mandip dhamoonm2, Pojen deng2, Eveline gutzwiller2, Qing Hao2, Celestine He2, Wilson D. Heredia Nunez2, Britany Klenofsky2, Hernan Nicolas Lemus2, Lara Marcus2, Veronica Peschansky2, Anuradha Singh2, Gabriela Tantillo2, James Young2, Parul Agarwal2, Priti Balchandani2, Nathalie Jette2. 1Medical Education, 2Neurology. 1,2Icahn School of Medicine at Mount Sinai, New York, NY.

123

IDENTIFYING AND RECRUITING AMERICAN DESCENDANTS OF SLAVERY (ADOS) IN MEDICAL SCHOOL APPLICATIONS: AN ANTI-RACIST FRAMEWORK. Stephanie Urena1, Michelle Sainté Willis1, Ann-Gel Palermo1.1Medical Education.

1 Icahn School of Medicine at Mount Sinai, New York, NY.

124

THE IMPACT OF STOOL FIT-DNA TESTING ON DISPARITIES IN COLORECTAL CANCER SCREENING. Roshan Vasoya1, Lina Jandorf2. 1Medical Education, 2Population Health Science and Policy. 1,2Icahn School of Medicine at Mount Sinai, New York, NY.

125

PROTOCADHERIN-7 REGULATES CONTRACTILITY OF MURINE HEPATIC STELLATE CELLS. Nicholas Venturini1, James Carter2, Scott Friedman2. 1Medical Education, 2 Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, NY.

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127

128

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DISPARITIES IN ACCESS TO CARDIOVASCULAR PREVENTIVE SERVICES BY SOCIOECONOMIC STATUS. Hannah Verma1, Jonathan Hong2, Shiwani Mahajan3, Reed Mszar3, Gowtham Grandhi4, Nihar Desai5, Salim Virani6, Khurram Nasir6, Javier Valero7.

1 Medical Education, 2,7Cardiovascular Surgery, 4Medicine. 1Icahn School of Medicine at Mount Sinai, New York, NY, 2Northwestern University, 3Yale New Haven Health, 4 MedStar Union Memorial Hospital, 5Yale School of Medicine, 6 Michael E. DeBakey Veterans Affairs Medical Center, 7 Houston Methodist DeBakey Heart and Vascular Center.

FAILURES OF CARDIOVASCULAR HEALTH POLICY IN SOUTHERN STATES: TRENDS IN GEOGRAPHIC DISPARITIES IN UTILIZATION OF CARDIOVASCULAR PREVENTIVE SERVICES. Hannah Verma1, Stephen Latham2. 1Medical Education, 2Bioethics.

1 Icahn School of Medicine at Mount Sinai, New York, NY, 2Yale University.

IMPACT OF VIRTUAL-REALITY-GUIDED MINDFULNESS ON FOCUS PRIOR TO HIGH-FIDELITY SIMULATION DEBRIEF. Brett Weingart1, Garrett Burnett2, Stephanie Hojsak2, Daniel Katz2.

1 Medical Education, 2Anesthesiology. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. WHAT FACES REVEAL: THE LEGACY OF HUGH DIAMOND’S PHOTOGRAPHIC REPRESENTATIONS OF MENTAL ILLNESS. Sara Wetzler1, James Curely-Egan2. 1Medical Education, 2Psychiatry.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. HOW DOES SMOKING TOBACCO IMPACT LONG-TERM OUTCOMES FOLLOWING TOTAL SHOULDER ARTHROPLASTY? Christopher White1, Akshar Patel2, Kevin Wang2, Carl Cirino2, Benjamin Gross2, Bradford Parsons2, Evan Flatow2, Paul Cagle2.

1 Medical Education, 2Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, NY.

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ASSOCIATION BETWEEN SERUM VITAMIN D LEVELS AND MYOPIA IN THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY (2001-2006).

Amber Wolf1, Louis Pasquale2, Bian Liu3, Sumayya Ahmad2.

1 Medical Education, 2Ophthalmology, 3 Population Health Science and Policy.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, NY. “I DEPEND ON HER FOR EVERYTHING”: CHARACTERIZING THE ROLE OF HOME CARE WORKERS CARING FOR HOMEBOUND OLDER ADULTS DURING THE COVID-19 PANDEMIC THROUGH A MIXED-METHODS STUDY. Emily Xu1, Patricia Kim2, Cynthia Yee2, Meng Zhang3, Jennifer Reckrey2, Sara Lubetsky2, Katherine Ornstein2, Emily Franzosa2. 1Medical Education, 2Geriatrics and Palliative Medicine, 3Medicine. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. ADVANCED AGE AS A RISK FACTOR FOR PERIOPERATIVE COMPLICATIONS AND 30-DAY AND 90-DAY READMISSIONS IN PATIENTS UNDERGOING SINGLE LEVEL ANTERIOR CERVICAL DISCECTOMY AND FUSION. Brandon J. Yeshoua1, Sirjanhar Singh 3, Helen Liu1, Nima Assad1, Sara D. Pasik1, Justin E. Tang1, Akshar Patel1, Kush C. Shah1, William Ranson2, Jun S. Kim2, Samuel K. Cho2. 1Medical Education, 2Orthopedics. 1,2Icahn School of Medicine at Mount Sinai, New York, NY, 3Orthopaedics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. CHOROIDAL EFFUSIONS REQUIRING SURGICAL INTERVENTION FOLLOWING GLAUCOMA DRAINAGE IMPLANT SURGERY: RISK FACTORS AND MANAGEMENT. Stephanie Ying1, Sara Coulon2, Alcina Lidder2, Mary Labowsky3, Kateki Vinod3, Paul Sidoti3, Joseph Panarelli2. 1Medical Education, 2,3Ophthalmology.

1 Icahn School of Medicine at Mount Sinai, New York, NY, 2NYU Langone, 3 New York Eye and Ear Infirmary.

PREDICTIVE POWER OF MACHINE LEARNING MODELS IN FECAL MICROBIOTA TRANSPLANT FOR INFLAMMATORY BOWEL DISEASE. David Youssef1, Matthew Stapylton2, Jose Clemente2.

1 Medical Education, 2Genetics and Genomic Sciences.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY.

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DYNAMIC IMAGING OF VITREOUS CORTEX HYALOCYTES USING ADAPTIVE OPTICS SCANNING LIGHT OPHTHALMOSCOPY IN HUMAN SUBJECTS. Rebecca Zhou1, Justin Migacz2, Richard Rosen2, Toco Y.P. Chui2.

1 Medical Education, 2Ophthalmology. 1Icahn School of Medicine at Mount Sinai, New York, NY, 2New York Eye and Ear Infirmary at Mount Sinai, New York, NY. TRANSCAROTID ARTERY REVASCULARIZATION IS ASSOCIATED WITH REDUCED ADVERSE IN-HOSPITAL EVENTS AND BETTER LONG-TERM SURVIVAL COMPARED TO TRANSFEMORAL CAROTID ARTERY STENTING. Jerry Zhu1, Ajit Rao2. 1Medical Education, 2Surgery, 1,2Icahn School of Medicine at Mount Sinai, New York, NY. OVARIAN RESERVE AND OOCYTE STIMULATION RESPONSE BETWEEN PATIENTS UNDERGOING ONCOFERTILITY PRESERVATION COMPARED TO NON-CANCER PATIENTS. Alexis L. Zachem1, Devora Aharon2, Alan Copperman2. 1Medical Education, 2 Medicine. Icahn School of Medicine at Mount Sinai, New York, NY.

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SECTION 2:

Abstracts 37

ABSTRACT 1 DELAY IN CARE FOR APPENDICITIS DURING THE COVID-19 PANDEMIC. Ava Adler1, Shruti Zaveri2, Venu Bangla2, Sean Johnson2, Alycia So2, Tyler D'Ovidio3, Celia Divino2.

1 Medical Education, 2Surgery. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: The COVID-19 pandemic caused fear with going to the hospital, causing hospital admissions to dramatically decrease. This caused concern for patients with appendicitis where delays can lead to the perforation of the appendix and increased risk of complications. The goal of this study is to illuminate the unknown impacts of the pandemic on the outcome of appendicitis. The study will assess both whether patients presented to the hospital later after onset of symptoms and if there was a difference in outcome.

HYPOTHESIS: The hypothesis is that patients with appendicitis presented later after onset of symptoms resulting in worse outcomes.

METHODS: Patients over the age of 18 who were admitted with appendicitis at a large academic hospital between January 2019 and January 2021 were identified. Variables in this study were derived from a retrospective chart review. One group consisted of patients who presented before the COVID pandemic and the other group consisted of patients who presented during the COVID pandemic. Differences in patient, disease, and management characteristics were analyzed between the two groups.

RESULTS: The study population consisted of 179 adult appendicitis patients with 89 patients in the preCOVID group (2019) and 90 patients in the COVID-era group (2020). In 2019, the median age was 34 years old (53.9% male and 46.1% female). In 2020, the median age was 43 years old (male 50% and female 50%).

Race/Ethnicity (pre-COVID, COVID-era) included Non-Hispanic White (47.2%,33.3%), Non-Hispanic Black (14.6%,15.6%), Hispanic (11.2%,18.9%), Asian/Pacific Islander (5.6%,6.7%) and Other (21.4%,25.6%).

Patient age, gender distribution, race/ethnicity, chief complaint, insurance status, and ASA score did not vary significantly between the pre-COVID (2019) and COVID-era (2020) periods or between the pre-lockdown and post-lockdown periods. There was however a dramatic delay in presentation and increase in rates of complicated appendicitis, 30.4% pre-lockdown and 52.3% post-lockdown (p=0.035).

CONCLUSION: We demonstrate in this study that patients with appendicitis during the lock-down presented later after symptom onset resulting in an increase in more complicated presentations for an otherwise easily treatable condition. One future project includes looking at pandemic outcomes of other emergent conditions.

As fear from the pandemic lingers and new variants arise, patients should still be empowered to seek care.

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ABSTRACT 2 ROLE FOR POLYCOMB REPRESSIVE COMPLEX 2 (PRC2) MEDIATED GENE REGULATION IN HUNTINGTON'S DISEASE. Sahil Agrawal1, Yong Loh2, Anne Schaefer2. 1Medical Education, 2Neuroscience.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. Normal brain function is contingent on proper interaction between specialized neurons that exhibit distinct anatomical, molecular, and functional features. These neuronal subtypes are established early in development by regulation of gene expression programs that guide neural progenitor cells into terminally differentiated neurons. Once established, these neuronal subtype specific transcriptional programs must be maintained throughout the lifespan of the organism, as alterations to this specification are a feature of many neurodegenerative disorders, including Huntington’s disease (HD). Our lab previously identified that the Polycomb Repressive Complex 2 (PRC2), which catalyzes the tri-methylation of histone H3 at lysine 27 (H3K27me3) and inhibits gene transcription, helps to maintain neuron-type specific transcription networks in adult neurons. PRC2 deficiency leads to neuronal transcriptional and functional changes and neurodegeneration that is highly reminiscent of HD in mice and humans, suggesting a possible contribution of PRC2 dysregulation to HD etiology. This work presents evidence in two different mouse models of HD of an early loss of H3K27me3 in the striatum. We found that loss of H3K27me3 occurs in a temporal and CAGlength dependent manner at PRC2 target genes that are also induced in HD. We then assessed whether preventing the induction of these genes by maintaining H3K27me3 could mitigate neurodegeneration by generating mice that lack the H3K27me3 demethylases, Kdm6a/b, in neurons. We found that loss of the demethylases in the context of HD or PRC2 deficiency partly restored H3K27me3 loss, reduced the severity of transcriptional changes, and ameliorated behavioral deficits. These data suggest a consequential role for H3K27me3-mediated gene regulation during early disease progression in HD and extend our understanding of epigenetic and transcriptional dysregulation in the disease.

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ABSTRACT 3 FLAVOPROTEIN FLUORESCENCE (FPF) MONITORING IN PATIENTS WITH EXUDATIVE AGE-RELATED MACULAR DEGENERATION (AMD) BEFORE AND AFTER ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR (ANTI-VEGF) TREATMENT. Sofia Ahsanuddin1, Oscar Otero-Marquez2, Collin Rich3, Richard Rosen4. 1Medical Education, 2,3,4 Ophthalmology. 1,4Icahn School of Medicine at Mount Sinai, New York, NY, 2New York Eye and Ear Infirmary of Mount Sinai, New York, NY, 3OcuSciences Inc., Ann Arbor, MI. BACKGROUND: Oxidative stress is implicated in the pathophysiology of several retinal diseases such as exudative age-related macular degeneration (AMD). The degree of oxidative stress is thought to be correlated with retinal flavoprotein fluorescence (FPF). Whether FPF changes as a result of anti-vascular endothelial growth factor (anti-VEGF) treatment remains unclear. We hypothesize that anti-VEGF treatment improves FPF in wet AMD patients, changes which may be correlated with improvement in best corrected visual acuity (BCVA) and OCT central macular thickness (CMT).

METHODS: This was a prospective observational cohort study conducted at a single institution from October to December 2021. 5 eyes from 5 wet AMD patients and 10 eyes from 10 healthy controls were imaged non-invasively using a specialized fundus camera OcuMet Beacon (OcuSciences, Ann Arbor, MI). During each imaging session, the macula was imaged with a narrow blue light in a narrow emission spectra from 520 to 540 nm. A single 3x3 mm macular OCT-A scan (Avanti RTVue-XR; Optovue, Fremont, CA, USA) was obtained. Nonparametric independent t-tests were performed to compare changes between FPF, BCVA, and CMT values prior to and after anti-VEGF injection at an initial visit and at a follow-up visit with an interval range of 36 - 67 days. Spearman rank correlation coefficients were calculated to assess the relationship between FPF and BCVA and FPF and CMT. RESULTS: FPF values both before and after anti-VEGF treatment were significantly greater than those of healthy controls (p < 0.01, p < 0.01, respectively). Mean FPF values for the wet AMD patient cohort were found to increase from 59.00 to 67.60 after anti-VEGF treatment. BCVA and CMT were both found to improve after anti-VEGF treatment from a mean of 0.146 to 0.124 and 252.8 to 246.8, respectively. FPF values were negatively correlated with BCVA (r = -0.578, p = 0.008). There was no correlation between FPF values and OCT CMT (r = 0.011, p = 0.963).

CONCLUSIONS: These data indicate that FPF may be a potential biomarker for retinal oxidative stress. In advanced wet AMD, anti-VEGF treatment does not reduce levels of FPF to those seen in healthy controls. It is possible that FPF values increased after anti-VEGF treatment due to retinal hypoxia. Consistent with previous findings, the data in this study indicate that FPF is inversely correlated with BCVA. More data is needed to elucidate these differences in a larger cohort of patients.

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ABSTRACT 4 CERVICAL EPIDURAL STEROID INJECTIONS (CESI) ARE NOT ASSOCIATED WITH INCREASED RISK OF INFECTION, EPIDURAL HEMATOMA, REVISION RATES, WOUND COMPLICATIONS OR COMBINED COMPLICATIONS IN ANTERIOR CERVICAL DISCECTOMY AND FUSION (ACDF).

Husni Alasadi1, Zakaria Chakrani1, Nicole Zubizarreta2, Jashvant Poeran2, Saad Chaudhary2.

1 Medical Education, 2Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Cervical epidural steroid injections (CESIs) are widely used to alleviate pain caused by intervertebral disc herniation, stenosis, or radiculopathy. No previous studies have assessed their effect on epidural hematoma, revision rates, or wound complications following Anterior Cervical Discectomy and Fusion (ACDF) in the cervical region. Therefore, using national data, we aimed to explore 1) patient characteristics associated with CESI administration, and 2) whether an association exists between preoperative CESIs and a variety of serious complications following ACDF. METHODS: We retrospectively queried the IBM MarketScan national database and included adult patients that had undergone inpatient or outpatient ACDF due to disc herniation, stenosis, radiculopathy, or myelopathy from Jan 2014 to Sep 2017. Current procedural terminology codes were used to identify patients who received a CESI within 1 year prior to their ACDF. Descriptive statistics and multivariable regression modeling were applied to characterize the patients more likely to receive a CESI and to measure the association between pre-operative CESI and post-ACDF 90-day infection, epidural hematoma, wound complications, revision surgery, or combined complications (the former first three complications). We report odds ratios (OR) and 95% confidence intervals (CI).

RESULTS: Among 37,768 patients, 11,538 (30.5%) received a CESI. Higher odds of receiving a CESI were seen for patients with a herniation diagnosis (OR, 1.07; 95% CI, 1.03-1.12; P < 0.0001), radiculopathy (OR, 1.43; 95% CI, 1.37-1.50; P < 0.0001), those from the North Central region (OR, 1.11; 95% CI, 1.05-1.17; P < 0.0001) or from the South (OR, 1.15; 95% CI, 1.07-1.23; P < 0.0001). Importantly, we did not observe significant associations between pre-operative CESI and post-ACDF infection (OR, 1.06; 95% CI, 0.81-1.38; P = 0.669), epidural hematoma (OR, 0.83; 95% CI, 0.49-1.40; P = 0.485), revision surgery (OR, 1.01; 95% CI, 0.76-1.35; P = 0.956), wound complications (OR, 0.99; 95% CI, 0.77-1.27; P = 0.948) or combined complications (OR, 0.98; 95% CI, 0.80-1.20; P = 0.824).

CONCLUSION: Diagnosis type, geographic region and comorbidity burden are main determinants of CESI receipt. We found no association between CESI and the studied post-ACDF complications. Further research is needed to better delineate the complication profile related to surgical treatment of cervical pathologies following pain management modalities and CESIs.

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ABSTRACT 5 SYNERGY OF CAD INHIBITION AND ERASTIN IN PTEN DEFICIENT CELLS. David Allely1, Kaitlyn Fragogiannis2, Ramon Parsons2. 1Medical Education, 2Oncological Sciences.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: PTEN’s canonical function as a tumor suppressor is mediated by the dephosphorylation of PIP3 to PIP2, which reduces the activity of PDK1, AKT, and other targets and subsequently, inhibits cell cycle progression, cell growth, and survival. Previously unknown was PTEN’s regulation of ferroptosis during its tumor suppressor function and recently our lab discovered that PTEN activity increases sensitivity to ferroptosis. Specifically, PTEN inhibits AKT and reduces its capability to phosphorylate GSK-3beta.

Unphosphorylated GSK3-beta is then active and phosphorylates NRF2, allowing its negative regulator BTrCP to recognize and ubiquinate NRF2, leading to its proteasomal degradation. Less NRF2 translocates to the nucleus, decreasing transcription of its target genes, such as SLC7A11 (which encodes xCT). This lowers expression of xCT, a glutamate/cystine antiporter on the surface of cells. Depletion of xCT leads to lower cystine uptake and subsequently lower levels of intracellular glutathione. Due to less glutathione available to scavenge out lipid ROS, cells have increased sensitivity to Erastin-induced ferroptosis. Losing PTEN, resulting in elevated AKT activity, leads to resistance to ferroptosis, but combining inhibition of AKT with erastin is able to retrigger ferroptosis in these cells. Exploration into mechanisms to rescue ferroptosis resistance in PTEN deficient cells led to the investigation of PALA, an inhibitor of CAD. METHODS: A series of PTEN wild-type and PTEN deficient cancer cell lines were maintained in tissue culture and seeded onto plates for titration with PALA. Cells were plated using their specific growth media and allowed to seed for 24 hours. After seeding, media was removed and replaced with the same media that included a 1:200 dilution with DRAQ-7, to allow visualization of cell death in the Incucyte. PALA was titrated, the highest concentration of PALA used was 4mM, with eight additional columns of stepwise 1:1 dilutions of PALA and a control column without PALA. Scans were done in the Incucyte every 6 hours and the experiments were allowed to run for 10 days each. Media/titration replacement was performed on day 5 to ensure the media was fresh for the length of the experiment.

RESULTS: Inhibiting CAD, via PALA, rescues from the ferroptosis resistance you see in PTEN deficient cells.

Further research will help elucidate the mechanisms involved in PTEN’s regulation of ferroptosis.

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ABSTRACT 6 ASSOCIATIONS BETWEEN PRENATAL EXPOSURE TO FINE PARTICULATE MATTER AND AGE FOUR IMPULSE OSCILLOMETRY: EFFECT MODIFICATION BY MATERNAL ATOPY. Lauren Alpert1, Maritza Minchala2, Elena Colicino3, Ander Wilson4, Brent Coull5, Rosalind Wright2, Alison Lee2. 1Medical Education, 2Pediatrics, 3Environmental Medicine & Public Health. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY, 4Colorado State University, 5Harvard University.

BACKGROUND: Children with impaired lung function by school-age are at increased risk for later respiratory morbidity. Evidence links higher fine particulate matter (PM2.5) exposure in utero with poorer childhood lung function. Children whose mothers have atopic disease, including asthma, may be at particularly heightened risk, although this has not been widely studied.

OBJECTIVE: To examine time-varying associations between prenatal PM2.5 exposure and age four lung function, delineate windows of susceptibility during fetal development, and explore effect modification by maternal reported history of atopy.

METHODS: We leveraged the Programming of Intergenerational Stress Mechanisms (PRISM) pregnancy cohort in the Northeastern United States. Daily residential PM2.5 estimates at a 1x1 km resolution were generated across the course of pregnancy using a satellite-based hybrid model. Impulse oscillometry (IOS) was performed at age four (N=228) following ATS/ERS guidelines. IOS lung function variables included resistance at 5 Hertz (R5) and 20 Hertz (R20) and the difference between R5 and R20 (R5-20), reactance at 5 Hertz (X5), area of reactance (AX) and resonant frequency (Fres). We employed multivariable Bayesian distributed lag interactional models (BDLIMs) to estimate associations between prenatal PM2.5 exposure during each week of gestation and IOS outcomes considered individually with effect modification by maternal atopy.

RESULTS: Children (N=228) were median age 4 years (IQR 3.6, 4.8) at the time of IOS. The majority of children self-identified as non-Hispanic Black (N=139, 61%) or Hispanic (N=74, 32%) and N=127 (56%) mothers reported a prior atopy diagnosis. BDLIMs found that higher PM2.5 exposure in early gestation was associated with higher total airway (R5) and higher peripheral (small) airway (R5-20) resistance, more negative reactance (X5) and increased area under the reactance curve (AX), providing an overall picture consistent with airway dysanapsis associated with higher prenatal PM2.5 exposure. Children born to mothers with a history of atopy were more susceptible to the effects of PM2.5 on X5 and AX.

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ABSTRACT 7 THE DISAPPEARING ACT: MR IMAGING OF SCARPA'S FASCIA IN THE PERIUMBILICAL REGION FOR AUTOLOGOUS BREAST RECONSTRUCTION DECISION MAKING. Uchechukwu Amakiri1, Florence Doo2, Annet Kuruvilla3, Alexander Kagen2, Peter Henderson4.

1 Medical Education, 2Radiology, 4Surgery. 1,4Icahn School of Medicine at Mount Sinai, New York, NY, 2 Mount Sinai West, 3Stony Brook University Renaissance School of Medicine New York, NY. BACKGROUND: Scarpa’s (superficial) abdominal wall fascia is a key strength layer when closing the donor site after autologous abdomen-based breast reconstruction. Traditional closure closes Scarpa’s fascia across the entire length of the wound. Intraoperative observations, however, have revealed Scarpa’s fascia attenuation near the umbilicus. This finding has not been previously described and suggests that traditional closure techniques may increase the risk of fat necrosis near the abdominal midline.

OBJECTIVE: This project sought to analyze Scarpa’s fascia structure near the umbilicus, and compare patients who underwent a newly-described abbreviated Scarpa’s fascia closure technique against historical norms.

METHODS: This retrospective study included patients who underwent preoperative magnetic resonance angiography (MRA) before abdomen-based autologous breast reconstruction using an abbreviated closure technique, closing Scarpa’s fascia only where it was definitively observed to be present—the entire width of the incision excluding approximately 8 cm centered at the midline. Measurements were taken on MRA images to determine the terminus of Scarpa’s fascia around the umbilicus. These measurements were converted to surface area and compared after subdividing patients based on BMI and age. Patient charts were reviewed to determine donor site complications.

RESULTS: Sixty-six patients met inclusion criteria. The mean values of distance between Scarpa’s fascia endpoints and the umbilicus were: 4.6cm (rostral), 4.2cm (caudal), 4.7cm (left), and 4.5cm (right). The mean surface area of radiologic Scarpa’s fascia absence was 56.3cm2. There was a statistically significant difference in the surface area of Scarpa’s fascia absence around the umbilicus when compared for BMI (p = 0.003) and age (p = 0.013). The donor site complication rate was 7.6%.

CONCLUSION: MRA imaging revealed that Scarpa’s fascia functionally ends approximately 4.5 cm from the umbilicus in all directions; this finding varies with BMI and age. Literature shows a greater rate of abdominal site complication in traditional Scarpa’s fascia closure (approximately 13%) compared to our abbreviated technique (7.6%); this is likely due to increased incidence of fat necrosis due to sutures being placed near the midline where Scarpa’s fascia is in fact absent.

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ABSTRACT 8 EFFECTS OF PREGNANCY ON THE PHARMACOKINETICS OF ANTI-TNF BIOLOGICS IN WOMEN WITH INFLAMMATORY BOWEL DISEASE. Lily Ardente1, Gottlieb Zoe2, Marla Dubinsky3. 1Medical Education, 2Medicine, 3Pediatics.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Anti-tumor necrosis factor (anti-TNF) biologics are used to manage women with Inflammatory Bowel Disease (IBD), especially during pregnancy. Therapeutic drug monitoring is often used to optimize dosing to a threshold level associated with optimal efficacy. Earlier studies demonstrated in small cohorts that pregnancy impacts the pharmacokinetics of anti-TNFs. OBJECTIVE: We aim to analyze the impact of pregnancy on the pharmacokinetics of anti-TNF biologics from preconception through pregnancy.

METHODS: Retrospective chart review of the IBD Preconception and Pregnancy Planning Clinic database was performed. Patients managed with infliximab (IFX) and adalimumab (ADA) with at least one concentration measured during pregnancy were included. Variables included: demographics and biologic type, dosing, and concentrations (ug/mL) (Prometheus Labs, CA). Primary outcome was median levels at PC and all trimesters (T1, T2, T3). Secondary outcome was median change between consecutive timepoints.

Descriptive statistics (frequency for categorical and median (Interquartile range [IQR]) for continuous) were done. Univariate analyses, Kruskal-Wallis, and pairwise comparisons by Dunn’s and Wilcoxon rank tests assessed associations.

RESULTS: 49 pregnancies were analyzed. 32 were on IFX: 17 had Crohn’s Disease (CD) and 15 had Ulcerative Colitis (UC). 17 were on ADA: 14 had CD and 3 had UC. The mean age at diagnosis and delivery was 21.7 and 31 years, respectively. Median IFX dosage (mg/kg) was 7.5, 7.5, 10, and 10 every 8, 7, 6, and 7 weeks at PC, T1, T2, and T3, respectively. Median ADA dosage was 40mg every 2 weeks for all timepoints. Median IFX concentrations were 12.3 [7.55-18.2], 13.0 [8.7-21], 21.6 [12.8-32], and 34 [22.8-34] for PC, T1, T2, and T3, respectively. PC and T3 were significantly different (p=0.02). Median difference in IFX level was 0 from PC to T1, 12.4 T1 to T2, and 12.3 T2 to T3. There was no significant difference between timepoints. ADA concentrations were 13.7 [9.9-22.6], 22.2 [14.8-23.2], 15.3 [13.5-23], and 18.4 [11.7-22.1], for PC, T1, T2, and T3, respectively. There were no significant differences. Median difference in ADA levels were -0.4 PC to T1, 0.9 T1 to T2, and -1.45 T2 to T3. There was no significant difference between timepoints.

CONCLUSIONS: Infliximab pharmacokinetics are impacted by pregnancy specifically with higher levels in the third trimester suggesting timing of the last infusion prior to delivery may be adjusted.

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ABSTRACT 9 USE OF VIRTUAL PLATFORM FOR DELIVERY OF SIMULATION-BASED LAPAROSCOPIC TRAINING CURRICULUM TO LMICS. Zerubabbel Asfaw1, Rachel Todd1, Linda Zhang2. 1Medical Education, 2Surgery.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Laparoscopic surgery is rapidly expanding in low and middle-income countries (LMICs), yet many surgeons in LMICs have limited formal training in laparoscopy. In 2017, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) implemented Global Laparoscopic Advancement Program (GLAP), an in-person simulation-based laparoscopic training curriculum for surgeons in LMICs. In light of COVID-19, SAGES adapted GLAP to a virtual format, delivering this curriculum virtually over six months. This study explores the feasibility and efficacy of virtual laparoscopic simulation training in resource-limited settings.

METHODS: Participants from San Jose, Costa Rica and Leon, Mexico enrolled in the virtual GLAP curriculum, meeting biweekly for 2-hour didactic classes and 2-hour hands-on live simulation practice. Participants completed pre- and post-program surveys assessing their perception of simulation-based training.

Residents’ laparoscopic skills were evaluated using the Fundamental of Laparoscopic Surgery (FLS) exam during the initial and final weeks of the program.

RESULTS: Of the 23 total participants (11 attendings, 12 residents), 20 completed the pre-program survey and 19 completed the post-program survey, while 10 residents completed both pre- and post-evaluation of FLS skills. At completion of the program, residents were 38.2% faster in completing the bimanual transfer (2:15 vs 4:07, p< 0.05), 39% faster on the precision cutting (2:38 vs 4:14, p<0.05), and 171% faster on the endoloop task (1:16 vs 2:48, p< 0.05). There was no significant difference in completing intracorporeal (4:33 vs. 6:51, p=0.067) and extracorporeal knot tie (4:17 vs. 3:16, p= 0.205). On a Likert scale (1=worst, 5=best), participants appreciated the program’s quality (mean 4.68), effectiveness of teaching (mean 4.57), depth of content (mean 4.31), and quality of faculty (mean 4.74). Participants considered the practice sessions (47%) and access to mentors (32%) as their favorite aspects, while technical issues (32%) and class content (21%) were the least favorite aspects of the program.

CONCLUSIONS: A virtual simulation-based curriculum can be an effective training strategy for teaching laparoscopic skills to surgeons in LMICs. Participants improved their laparoscopic skills, and they appreciated the mentorship opportunity. Future programs can utilize a virtual platform as a low-cost, effective strategy for training laparoscopic skills in LMICs.

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ABSTRACT 10 ACCESS TO HORMONE THERAPY FOR THE TRANSGENDER COMMUNITY DURING COVID-19.

Nicholas Athayde-Rizzaro1, Mary Rojas1. 1Medical Education. 1Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: The COVID-19 pandemic disrupted access to healthcare for many, and disproportionately impacted marginalized groups, such as the transgender community. An integral component of healthcare for many transgender people is hormone therapy. We developed a survey to investigate whether participants experienced disruptions in hormone therapy during the peak of the COVID-19 pandemic.

HYPOTHESIS: Transgender people experienced disruption in access to hormone therapy during the COVID-19 pandemic.

METHODS: We disseminated an online survey to trans-specific social network groups between November 30 to December 4, 2020. The survey contained 39 multiple-choice and open-ended questions on access to healthcare during the COVID-19 pandemic. Eligible respondents had to live in the U.S., be over 18 years of age, and identify as transgender. Univariate and bivariate data analysis was conducted using SPSS. RESULTS: The 87 eligible respondents were predominantly white (77.6%), largely insured (93%), and 42% had a salary of 60k/year or above. 34% of respondents who reported being on hormone therapy experienced a disruption in their therapy. Out of these, 85% experienced issues with their healthcare provider or pharmacy.

Other reasons included hormone/needle shortage, loss of health insurance, and personal health issues.

CONCLUSIONS: Despite having a respondent pool that is relatively well-resourced compared to the general transgender population, over one third of respondents reported a disruption in their hormone therapy.

Telehealth can improve access to healthcare when in-person appointments are not an option, and pharmacy delivery services can increase access to medications. Telehealth services for hormone therapy exist but charge a monthly fee that is prohibitive for many. Nonetheless, these could serve as a model for healthcare centers in how to approach hormone therapy care remotely.

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ABSTRACT 11 MEDICAL MISTRUST AND PALLIATIVE CARE PERCEPTIONS IN RACIALLY AND ETHNICALLY DIVERSE PATIENTS WITH ADVANCED STAGE LUNG CANCER. Amina Avril1, Melissa Mazor2, Jose Morillo2, Cardinale Smith2. 1Medical Education, 2 Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Palliative care (PC) is an understudied area of health equity. There is evidence that medical mistrust contributes to the underutilization of health care services, but little is known about the relationship between medical mistrust and perceptions of palliative care in ethnically and racially diverse patients with advanced lung cancer.

OBJECTIVE: To evaluate differences in medical mistrust (MM) and perceptions of palliative care (PPC) and to examine the associations between MM and PPC between minority (Black and Hispanic) and non-minority (Non-Hispanic White) patients with advanced stage (stages III and IV) lung cancer.

METHODS: We evaluated baseline data from a pilot cohort study examining disparities in PC and hospice use in patients with advanced stage lung cancer. Participants completed validated measures of MM (Group Based Medical Mistrust Scale) and cognitive, emotional, and global PPC (PPC Instrument). Wilcoxon and Chi-square analyses were used to compare differences in MM and PPC, respectively, between minority and non-minority patients. Unadjusted logistic regression was used to assess the association between MM and PPC. RESULTS: Of the 99 lung cancer patients, 56% were Black or Hispanic. There were no differences in mean (SD) age between minority and non-minority patients [63.6 (10.6) vs 66.2 (9.7), p=.19]. Minority patients were more likely to report being non-married, have less than high school education, and lower household income, p<.01 for all). Relative to non-minority patients, minorities were more likely to report their PC perceptions as hopeless (36% vs 15%, p=.04) and disrupted (53% vs 30%, p=.03). Mean MM scores between minority and non-minority patients [33.2 (5.9) vs 31.6 (4.5), p=.49] were not associated with cognitive, emotional, or global PPC. CONCLUSIONS: While findings suggest that MM is more common among minorities, our study did not reflect those trends and MM was not associated with PPC in diverse patients with advanced lung cancer. Future studies should consider the influence of social barriers like educational disparities and healthcare access on Black and Hispanic patient’s PPC and if these perceptions impact utilization of PC. Providers should address PC knowledge gaps and assess social and cultural PC preferences such as spiritual practices and social support to enhance alignment of PC goals.

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ABSTRACT 12 SARS-COV-2 MRNA VACCINATION ELICITS ROBUST SPIKE ANTIBODY RESPONSES IN PEOPLE WITH HIV. Arman Azad1, María Carolina Bermúdez González2, Komal Srivastava2, Charles Gleason2, Katherine Beach2, Levy Sominsky2, Annika Oostenink2, Gianna Cai2, Juan Manuel Carreño Quiroz2, Dominika Bielak2, Gagandeep Singh2, PVI Study Group2, Florian Krammer3, Luz Amarilis Lugo3, Viviana Simon2. 1Medical Education, 2Microbiology, 3Infectious Diseases.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: It remains a matter of debate whether people with HIV (PWH) experience increased COVID-19 morbidity and mortality, particularly individuals with low CD4+ T cell counts and/or without access to effective antiretroviral therapy. We characterized the humoral immune responses mounted upon SARSCoV-2 infection and/or vaccination in a cohort of 52 people with HIV on antiretroviral therapy.

METHODS: We began collecting biospecimen and clinical data from people with HIV and COVID-19 in April 2020 as part of an ongoing longitudinal observational IRB approved study. All PWH were on antiretroviral treatment at baseline. We assessed SARS-CoV-2 spike binding IgG antibody titers using an enzyme-linked immunosorbent assay (measured as area under the curve) and collected clinical data through questionnaires and electronic health record review. Antibody levels in PWH were compared to those of 394 participants without HIV enrolled in the Protection Associated with Rapid Immunity to SARS-CoV-2 (PARIS) study.

RESULTS: The average CD4 count in participants with HIV was 676/mm3 and HIV viral loads were below the limit of detection in a majority of participants. Average participant age at baseline was 51.8 years (SD 9.8). The gender identity and sex at birth of our participants was predominantly male (42/52 and 44/52, respectively).

134 distinct serum/plasma samples were analyzed from 52 participants with HIV. Of those, 79 samples were collected in participants with known SARS-CoV-2 infection and 47 samples were collected after vaccination.

Both pre- and post-vaccine samples were available for 27 participants. There was considerable variation in antibody titers after natural infection in PWH (median AUC 253.4, range: not detected to 13,202). 47/52 PWH received at least one dose of COVID-19 vaccine (37 Pfizer, 9 Moderna, 1 Sinovac). SARS-CoV-2 spike binding antibodies after mRNA vaccination in PWH were not significantly different than titers in people without HIV (Mann Whitney U test after 140 days).

CONCLUSION: Our data show that SARS-CoV-2 spike binding IgG antibody levels vary substantially after natural infection in people with well-controlled HIV. After mRNA vaccination, people with well-controlled HIV mount spike binding IgG antibody levels comparable to those observed in people without HIV. So far, no SARS-CoV-2 infections have been identified in fully immunized participants with HIV enrolled in our studies.

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ABSTRACT 13 ILIAC VEIN STENOSIS ACCENTUATED SYMPTOMS OF THORACIC OUTLET SYNDROME. Halbert Bai1, Arthur Jenkins2, Michael Marin3, Windsor Ting3. 1Medical Education, 2Neurosurgery, 3 Surgery. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: We unexpectedly observed many patients undergoing iliac vein stenting for chronic proximal venous outflow obstruction (PVOO) also had symptoms suggestive of Thoracic Outlet Syndrome (TOS). We undertook this study to better understand this association.

METHODS: 99 consecutive patients who underwent iliac vein stenting for chronic PVOO at a single tertiary hospital from December 2019 to June 2021 were retrospectively reviewed. Patients with no follow-up, prior vein stenting, and acute deep vein thrombosis were excluded. Symptomatic TOS was diagnosed when two or more of the following symptoms of TOS were present in the upper extremities: weakness, numbness/ paresthesia, edema, pain, shoulder pain, upper back pain, neck pain, or impaired arm abduction. Categorical variables were analyzed by using Fisher’s exact tests and continuous variables were compared by using twosample Welch t-test.

RESULTS: Two or more symptoms of TOS were found in 62 patients (62.6%). Subclavian venogram performed in 76 patients with PVOO showed 70 (70.7%) had subclavian stenosis and/or thrombosis present.

Documented TOS symptoms include upper extremity weakness (28.3%), numbness (67.7%), upper back pain (50.5%), impaired arm abduction (10.1%), carpal tunnel (3.0%), shoulder pain (50.5%), neck pain (37.4%), and finger paresthesia (34.3%).

Comparing symptomatic TOS to those without symptoms, preoperative Venous Clinical Severity Score composite scores (TOS: 7.9±2.7 vs. Non-TOS: 7.6±3.0, P=0.643), Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) class (3.1±0.7 vs 3.4±0.9, P=0.137), stent laterality (P=0.342), and number of stents (2.0±0.7 vs. 1.8±0.7, P=0.275) were similar. All patients were seen postoperatively with a mean postoperative follow-up time of 39.3 days. Among TOS patients, improvement was seen in upper extremity weakness (33.9%), numbness (45.2%), shoulder pain (69.4%), neck pain (58.1%), finger paresthesia (46.8%), and upper back pain (75.8%).

CONCLUSIONS: This study showed that TOS symptoms are common in patients with chronic PVOO undergoing vein stenting, suggesting an important and previously unrecognized concurrence. We hypothesize that while lower extremity symptoms distal to the iliac stenosis from venous hypertension are known, PVOO may also cause symptoms which are cephalad to the iliac stenosis. The precise pathophysiology of these TOS-like symptoms is unclear but may be related to collaterals in a venous circulation that are interconnected.

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ABSTRACT 14 CARDIAC CORONARY TOMOGRAPHY ANGIOGRAPHY (CCTA) USE ACROSS GEOGRAPHIC REGIONS IN THE UNITED STATES AND THE UNITED KINGDOM. Bryana Banashefski1, Rita Redberg2. 1Medical Education, 2Cardiology.

1 Icahn School of Medicine at Mount Sinai, New York, NY, 2UCSF, San Francisco, CA. BACKGROUND: Low-value diagnostic imaging is a key component of unsustainable rising healthcare costs internationally. There is variation in use cardiac coronary tomography angiography (CCTA) in the care of patients with suspected coronary artery disease (CAD). Understanding payer coverage policies can help inform the development of high-value care initiatives and appropriate use of CCTA. OBJECTIVE: We aimed to describe regional differences in the United States (US) and the United Kingdom (UK) coverage policies and utilization of CCTA as well as in prevalence of CT scanners.

METHODS: First, we characterized US Medicare Administrative Contractor (MAC) coverage policies for CCTA. Next, using 2018 Medicare Part B data and Stata statistical software, we used chi-squared tests to determine differences between CCTA orders by MAC region. Then, we estimated odds ratios using logistic regression to determine the magnitudes of differences in order totals between groups. We then compared both CCTA use and computed tomography (CT) scanner prevalence in the US and UK. UK CCTA use was sourced from National Health Service (NHS) records. CT scanner data was sourced from the Organization for Economic Co-operation and Development’s 2020 Health Equipment report.

RESULTS: Policies in the US for CCTA varied in the level of CAD pre-test probability required and whether a stress test was required prior to use. There were significant differences in CCTA use per 100,000 beneficiaries, ranging from 74 to 313 across MAC regions. Physicians in MAC regions covering New England and Florida were twice as likely to order a CCTA than physicians in the Southeast MAC region (New England MAC odds ratio = 2.2, 95% CI 2.2-2.3; Florida MAC odds ratio = 2.16, Cl 2.1-2.2). In the UK, regional CCTA orders ranged from 34 to 118 per 100,000 NHS beneficiaries. The US has 4.2 CT scanners per 100,000; the UK has 0.9 per 100,000.

CONCLUSIONS: There is significant variation in coverage policies for and use of CCTA, likely reflecting the lack of high-quality evidence of clinical benefit for this imaging modality. Our study is limited by lack of data on indication for CCTA. These findings underscore the importance of evidence-based coverage policy to promote appropriate use of the CCTA.

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ABSTRACT 15 IMPACT OF BOVINE MILK EXTRACELLULAR VESICLES AND THEIR MICRORNA CARGOES ON HUMAN CARDIAC FIBROBLASTS. Nestor Bedoya1, Yassine Sassi2. 1Medical Education, 2Pharmacology and Systems Therapeutics. 1Icahn School of Medicine at Mount Sinai, New York, NY, 2Fralin Biomedical Research Institute at VTC (Virginia Tech).

BACKGROUND: As a graduate student, I investigated the effect of bovine milk extracellular vesicles (EVs) in cardiac tissue. I was able to show that introducing EVs in vitro led to an increase in the expression of miRNAs implicated in cardiovascular remodeling, one of the hallmarks of pathologic cardiac function. These findings imply that bovine milk consumption could theoretically affect gene expression of the heart via miRNA delivery to cardiac tissue postprandially. Clinically, this could lead to revisiting dairy dietary guidelines in clinical management of cardiovascular health.

OBJECTIVE: Given the importance of fibroblasts in cardiac function, the objective of my summer project was to assess whether bovine milk EVs could enter human cardiac fibroblasts (hCFs) and affect their miRNA expression in vitro.

METHODS: For all experiments, EVs were isolated from bovine milk according to the protocol described in my Master’s Thesis. Briefly, both raw bovine milk and bovine colostrum whey were subjected to serial centrifugation, followed by a sucrose density gradient isolation step performed overnight. Pelleted EVs were resuspended in 100μL of sterile PBS.To assess whether bovine milk EVs can be incorporated by hCFs in vitro, purified EVs were incubated with PKH67, a lipophilic fluorescent dye. Unbound dye was removed by centrifugation, and PKH-bound EVs were added to cell media for 24 hrs. EV incorporation was evaluated via fluorescent microscopy. To assess miRNA expression, hCFs were seeded into 12-well plates and cultured with 250μg/mL of reconstituted EVs. After 24 hrs, cells were washed with PBS twice, and TRIzol was used to detach cells and to prepare total cell RNA. 10 ng of total RNA were reverse-transcribed. cDNAs were quantified using SYBR Green, and modified primers for 5S miR-21, miR-148, miR-92a, and let-7a were used for qPCR quantification. For all experiments, hCFs were incubated in media with 10% Fetal Bovine Serum, and they were maintained in 5% CO2 at 37C. RESULTS: The microscopy study revealed that, similar to other cardiac cell types, bovine milk EVs can penetrate the cell membrane and localize in the cytoplasm of hCFs. This was demonstrated by the presence of green fluorescence perinuclearly. qPCR quantification showed statistically significant higher levels of all miRNAs assessed in hCFs treated with bovine milk EVs. These results suggest that these EVs deliver their miRNA contents to cells upon cell entry and affect hCF miRNA expression.

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ABSTRACT 16 IMPACT OF AN INTERDISCIPLINARY CARE PROGRAM ON PSYCHOSOCIAL OUTCOMES IN PATIENTS WITH RECENTLY DIAGNOSED INFLAMMATORY BOWEL DISEASE. Caroline Benson1, Laurie Keefer2, William Rivera Carrero2, Ryan Ungaro2.

1 Medical Education, 2Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Inflammatory Bowel Diseases (IBDs) are chronic conditions that can have a major impact on quality of life and psychosocial well-being. Interdisciplinary care (IDC) has been shown to improve clinical outcomes for established high risk IBD patients. However, there are limited data on the impact of IDC on psychosocial outcomes in newly diagnosed IBD patients.

METHODS: Patients with recent IBD diagnoses (≤18 months) were enrolled in a prospective registry at a tertiary IBD center. Some individuals chose to participate in an IDC program (COMPASS), which provided a comprehensive evaluation with an IBD specialist, nutritionist, social worker, and clinical pharmacist and the development of a personalized care plan. Controls were IBD patients enrolled in the registry who received standard of care (SOC). Psychosocial outcomes included the 10-item Connor-Davidson Resilience Scale (CD-RISC10), IBD Disability Index (IBD-DI) and IBD Self-Efficacy Scale (IBD-SE). Higher scores are desirable in CD-RISC10 and IBD-SE, while lower IBD-DI scores indicate less disability. Descriptive statistics were performed on demographic, clinical and psychosocial variables at baseline (BL) and 1 year with the main variable of interest being participation in the COMPASS IDC program. Two-tailed paired t-tests were performed for participants with paired psychosocial values (BL, 1 year).

RESULTS: Of the 225 patients included, 55% (n=124) participated in COMPASS and 45% (n=101) received SOC. The groups were similar in terms of age, sex, white race and disease activity (Partial Mayo Score for Ulcerative Colitis; HBI for Crohn’s Disease). 68 patients completed BL and year 1 questionnaires (47 COMPASS, 21 controls). Mean BL IBD-DI was higher for COMPASS vs. controls (p=0.046), while mean BL CD-RISC10 and IBD-SE were higher in controls vs. COMPASS. At 1 year, there was a significant decrease in IBD-DI from BL in both groups (mean decrease of 11.1 in controls, p=0.01; 7.8 in COMPASS, p=0.003). There was a significant increase in IBD-SE for COMPASS from BL to 1 year (mean increase of 14.4, p=0.049), while IBD-SE scores decreased in controls (p=0.7). No significant changes in CD-RISC10 were noted.

CONCLUSION: Participation in an IDC program significantly improved self-efficacy at 1 year in newly diagnosed IBD patients, suggesting that IDC programs can improve these patients’ abilities to self-manage their care. Future studies will examine the association of self-efficacy and healthcare utilization.

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ABSTRACT 17 A SYSTEMATIC REVIEW OF MALNUTRITION ASSESSMENT TOOLS IN THE PEDIATRIC POPULATION. Suzannah Bergstein1, Celine Soudant2, Mirna Chehade3. 1Medical Education, 3Pediatrics.

1,3 Icahn School of Medicine at Mount Sinai, New York, NY, 2Memorial Sloan Kettering New York, NY. BACKGROUND: Malnutrition is a widely tested metric in the pediatric population. Identification of a child with malnutrition is important to prevent developmental delay and other co-morbidities. Many of the models used to measure nutritional status of children have not been validated or compared.

RESEARCH QUESTION: What assessment tools are used to evaluate malnutrition in children, and what settings are they being used in?

METHODS: This systematic review searches the literature to compile different tools used to assess nutritional status in the pediatric population. A protocol adhering to PRISMA-P guidelines was developed, and four electronic databases (MEDLINE ALL (OVID), EMBASE (OVID), HAPI and Scopus) were used to identify articles published up until August 2020. Papers were included that incorporated a distinct nutrition tool and reported validity, reliability, and/or agreement data on the tool. Exclusion criteria included studies on adults and infants, animal studies, review studies, studies assessing nutritional intake as opposed to nutritional status, populations with different growth curves, and studies that only used height and weight to assess malnutrition. Literature search results were uploaded to Covidence for abstract and full-text screening.

RESULTS: The database search resulted 6,236 references. After the abstracts were screened, 1,151 abstracts fit the criteria and continued onto full-text review. 75 out of the 1,151 full texts were selected as meeting criteria for inclusion into the systematic review. Using the PRISMA-P protocol, data extraction and collection from the final 75 manuscripts is underway. The final studies incorporate nutrition tools tested in the settings of inpatient, ambulatory clinic and the community. Majority of the studies are prospective and cross-sectional, with a mix between single and multi-center focuses. The most highly studied tools thus far are arm circumference, skin fold thickness, and body composition measured by bioimpedance analysis.

The most reported validity tests of the tools are sensitivity and specificity, as well as positive and negative predictive values.

CONCLUSIONS: This review will provide physicians and researchers with the knowledge to determine which tool(s) may be most effective and applicable to test for malnutrition in their specific pediatric population.

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ABSTRACT 18 NATIONAL ANALYSIS OF RECONSTRUCTIVE AND SALVAGE HIP SURGERIES IN CHILDREN WITH CEREBRAL PALSY. Liam Butler1, Calista Dominy1, Thomas Li1, Abigail Allen2, Sheena Ranade2. 1Medical Education, 2 Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Children with cerebral palsy are commonly affected by hip dysplasia, and surgical intervention is generally necessary to improve functionality and quality of life. However, these procedures carry risk for various complications, long hospital stays, and readmissions. Much of the current literature documenting surgical outcomes consists of single institution studies with a wide range of follow up times and sample sizes.

OBJECTIVE: This study utilizes a national database to generate a comprehensive understanding of specific risk factors that impact surgical complications and hospital course.

METHODS: The National Readmissions Database 2014-2018 was queried for pediatric patients with a cerebral palsy diagnosis. Patients who underwent hip reconstructive or salvage surgery were selected for analysis. Data on demographics, comorbidities, length of stay (LOS), readmissions, complication rates, and cost analysis were collected for the total cohort. Inferential statistics were used to analyze data.

RESULTS: 1225 patients met the inclusion criteria. These patients had an average age of 9.3 ± 3.8 years old and were 42.8% female. 322 (26.3%) patients had a prolonged length of stay of at least 5 days, and 174 (14.2%) patients required readmission within 90 days of surgery. The average costs incurred by treatment for LOS less than 5 days ($64542 ± $35475) more than doubled for stays of at least 5 days ($131758 ± $146057).

Multiple factors were significant predictors for both elongated LOS and readmission including medical complications (LOS p<0.01; Readmission p<0.01), cardiac arrhythmias (LOS p<0.01; Readmission p=0.04), and iron deficiency anemia (LOS p=0.02; Readmission p<0.01). The all-cause complication rate was 5.5%, and Medicaid status was a significant predictor of sustaining an inpatient medical complication (p<0.01).

CONCLUSION: It is understood that children with cerebral palsy commonly have comorbidities that influence hip procedure outcomes and course. We expand on this by establishing a national readmission rate (14.2%) and identifying specific comorbidities that put patients at a greater risk for readmission and/or elongated LOS. Patients covered by Medicaid are also more likely to sustain complications during care. This study demonstrates the importance of ensuring adequate access to care and identifying specific comorbidities to improve patient outcomes and quality of life, as well as ease the financial burden on their families.

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ABSTRACT 19 PROLONGED OPIOID USE AFTER ORIF OF TIBIAL SHAFT FRACTURES. Zakaria Chakrani1, Husni Alasadi1, Brocha Stern2, Nicole Zubizarreta2, Jashvant Poeran2, David Forsh2.

1 Medical Education, 2Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. OBJECTIVE: The purpose of this study was to determine the rate of prolonged opioid use and associated risk factors following opioid exposure after tibial shaft surgery.

METHODS: This retrospective cohort study used IBM MarketScan national claims data (2014-2017). We identified 1,951 adult patients who filled a perioperative opioid prescription after open reduction and internal fixation of a tibial shaft fracture (ORIF), including an opioid-naïve subgroup of 1,508 patients. The primary outcome, prolonged opioid use, was defined as filling an opioid prescription between 91 and 180 days postoperatively. Adjusted odds ratios (OR) were calculated using multivariable logistic regression with backward selection to identify the association of different factors with prolonged opioid usage.

RESULTS: The rate of prolonged opioid use was 15.7% (n = 307) in the full cohort and 10.1% (n = 152) in the opioid-naïve subgroup. In the full cohort, factors significantly associated with increased odds of prolonged opioid use include age (OR, 1.03; 95% CI, 1.01-1.04; P < 0.001), total perioperative opioid dose in the top 25th percentile of oral morphine equivalents (OR, 2.48; 95% CI, 1.67-3.70; P < 0.001), perioperative morphine (OR, 1.93; 95% CI, 1.04-3.58; P = 0.037), perioperative tramadol (OR, 2.18; 95% CI, 1.43-3.31; P < 0.001), CharlsonDeyo comorbidity score of 2 (OR, 3.56; 95% CI, 1.64-7.73; P = 0.002), smoking (OR, 1.63; 95% CI, 1.09 to 2.44; P = 0.017), mood disorders (OR, 1.68; 95% CI, 1.08-2.62; P =0 .021), and pre-operative opioid use (OR, 3.91; 95% CI, 2.96-5.15; P < 0.001). In the opioid-naïve subgroup, age, total perioperative opioid dose in the top 25th percentile, perioperative tramadol, smoking, other pain disorders, and drug and substance use disorders were significantly associated with increased odds of prolonged opioid use.

CONCLUSION: Prolonged opioid use is not uncommon in this population. We identified factors that are linked with increased odds of prolonged opioid use after ORIF of a tibial shaft fracture. Pre-operative opioid use was the largest predictive factor of prolonged opioid use, but age, total perioperative opioid dose in the top 25th percentile of oral morphine equivalents, perioperative tramadol, and smoking were associated with increased odds of prolonged opioid use in both the full cohort and opioid-naïve subgroup. Physicians should consider these risk factors when prescribing opioids regardless of patients’ opioid use history.

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ABSTRACT 20 SINGLE-CELL ENTROPY SCORING DISCERNS TUMOR INITIATING CELL MARKERS IN NON-SMALL CELL LUNG CANCER. Daniel Charytonowicz1, Arpit Dave2, Kristin Beaumont2, Alexander Tsankov2, Robert Sebra2.

1 Medical Education, 2Genetics and Genomic Sciences. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Tumor Initiating Cells (TICs) are subpopulations of cancer cells believed to play a role in the development and progression of human cancers. Existing markers used to define these enigmatic cells, particularly in non-small cell lung cancer (NSCLC), are often inconsistently expressed and non-specific towards enrichment of pure progenitor-like populations. As current approaches towards the identification of TIC markers are largely driven by phenotypic screening and fluorescence based sorting methods, there is an urgent need for novel approaches for screening potential CSC markers.

RESEARCH QUESTION: Can we leverage the high-dimensional resolution of single cell transcriptomics to develop and apply a novel computational pipeline for the discovery of promising TIC marker gene candidates in NSCLC? METHODS: In this work, we introduce pySCE, a GPU-accelerated implementation of transcriptional entropy scoring, to identify putative progenitor cell markers across an integrated NSCLC single cell dataset. We leverage pySCE to rapidly compute exact entropy scores for 115,117 normal and 36,843 malignant lung epithelial cells collected and integrated from 10 studies and conduct an unbiased statistical assessment of entropy/gene expression correlation.

RESULTS: In normal lung tissue, we show that alignment of gene expression to entropy scores robustly negatively correlates with well-known markers of lung epithelial cell maturation. We then applied this pipeline to our unique, integrated NSCLC malignant cell dataset in search of putative TIC marker genes, recapitulating known progenitor-associated genes, as well as identifying gene sets with significant entropy-associated differences in expression. Subsequent gene set enrichment analysis revealed novel insights into mechanisms of tumor initiating cell microenvironmental niche adaptation across both primary and metastatic tumor types.

Lastly, we show how entropy-associated genes significantly correlate with clinical outcomes using orthogonal data sources, even across only subsets of genes with predicted cell-surface expression.

CONCLUSIONS: Our approach robustly recapitulates expression dynamics associated with healthy lung homeostasis and uncovers both known and novel marker genes associated with TICs in primary and metastatic lung cancer tissue, with both prognostic and therapeutic implications.

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ABSTRACT 21 SCALP AND SERUM PROFILING OF FRONTAL FIBROSING ALOPECIA. Sumanth Chennareddy1, Celina Dubin2, Jacob Glickman2, Ester Del Duca2, Emma Guttman2.

1 Medical Education, 2Dermatology. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Frontal fibrosing alopecia (FFA) is a slowly progressive alopecia of the frontotemporal scalp, eyebrow, and other facial hair, characterized by scarring. Currently, the etiology of the disease is poorly understood, although it may be partially caused by hormonal changes, environmental triggers, or autoimmune inflammation. Although the disease is associated with significant morbidity, the pathomechanisms of FFA are not well understood. To date, a large-scale molecular profiling of FFA has not yet been done, which unfortunately precludes the development of effective therapeutics.

OBJECTIVE: To characterize the scalp and serum molecular profile of FFA compared to normal and alopecia areata (AA) to identify dysregulated biomarkers that predict FFA disease severity, which may help identify novel therapeutics for FFA. METHODS: This is a cross-sectional study of 38 patients, including 12 patients with FFA, 18 with AA, and 8 healthy controls. Four-and-a-half-millimeter punch biopsies were obtained from healthy and diseased scalp in each of the patient groups, and patient serum was also analyzed. The study analyzed 33118 biomarkers in FFA, AA, and normal patient scalp using RNA sequencing and 350 proteins in FFA, AA, and normal patient serum using OLINK high-throughput proteomics. The clinical severity of disease will be correlated with disease biomarkers as well as a fibrosis gene subset.

RESULTS AND DISCUSSION: We noted a total of 969 differentially expressed genes in lesional FFA scalp compared to normal scalp. Notably, many genes related to the Th1 immune pathway were upregulated including IFNy, CXCL9, and CCL10, in addition to T-regulatory cell markers (FOXP3, TGFB1, and TGFB3) (indicating a Th1 skewed disease), T-cell activation markers (CD2, CD3, CCL19, ICOS), and janus kinase markers (JAK3/STAT1/STAT4). Perhaps most notably, many fibrosis markers were also significantly elevated in lesional FFA including chemokine receptor CXCR3, FGF14/FGF22, VIM and FN1. Interestingly, compared to other immune-mediated diseases, FFA did not show significant serum dysregulation. The lack of systemic dysregulation may indicate why FFA is confined to the scalp, whereas other inflammatory skin disease may manifest on many body surfaces. We noted a positive correlation between JAK/STAT markers and fibrosis, which may indicate that therapeutics targeting the JAK/STAT pathway may be effective in modifying disease in FFA.

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ABSTRACT 22 MICROSIMULATION MODELING TO INVESTIGATE COST-EFFECTIVENESS OF SURGICAL TREATMENT FOR ISCHEMIC HEART FAILURE. Susmita Chennareddy1, Bart Ferket2. 1Medical Education, 2Population Health Science and Policy.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Heart failure (HF) is one of the leading causes of mortality in the United States, currently affecting over 6.2 million Americans. Nearly half of all patients with HF have reduced ejection fraction (HFrEF), which has been associated with a further increase in mortality. In patients with HFrEF and ischemic cardiomyopathy, the major cause for HFrEF, adding coronary artery bypass graft (CABG) surgery was shown to reduce long-term mortality and major adverse cardiac events (MACE) compared to guideline-based medical therapy (GDMT) alone. However, CABG increases early morbidity and mortality and is more costly than medical therapies. These trade-offs between cost, early risks, and long-term benefits—which may be different in every patient—make treatment decision-making particularly complex for ischemic HFrEF. Moreover, GDMT has expanded over the past decade to include new pharmacological therapies, which may narrow the effect size of long-term benefits provided by CABG. OBJECTIVE: To investigate the health benefits, risks, and cost-effectiveness of CABG compared to current, more advanced GDMT, in the context of various patient subsets.

METHODS: The microsimulation model was developed using the 1,212 participants in the Surgical Treatment for Ischemic Heart Failure (STICH) trial as the source for probabilities, hazard rates, and odds ratios for mortality, heart failure, and CABG outcomes. Literature-based estimates of efficacy of novel HFrEF medications were used to update outcomes of GDMT prior to comparison between CABG and GDMT with GDMT alone. Model validation is currently underway. After validation, we plan to compare long-term health and economic outcomes of each treatment strategy within a formal cost-effectiveness analysis, using publicly available reimbursement data for costs and survival modeling outcomes for effectiveness.

PRELIMINARY RESULTS: After a 6-year, ten-trial simulation in patients with HFrEF receiving CABG and GDMT, 39.3% of patients died and 26.9% had hospitalization due to heart failure. In patients randomized to GDMT alone, 46.2% died, 32.4% had heart failure hospitalization, and 15.5% received CABG. CABG, mortality, and heart failure hospitalization models have been validated. Model validation of the 11-year, ten-trial simulation is currently underway with the STICH Extension Study (STICHES) dataset.

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ABSTRACT 23 MATURATION OF TELEMEDICINE THROUGHOUT THE PANDEMIC: EXPERIENCES FROM PRIMARY CARE PRACTICES ACROSS THE US. Logan Cho1 , Natalie Benda2, Samantha Serrano3, Katerina Andreadis4, Crispin Goytia3, Jenny J. Lin5, Carol Horowitz3, Jessica Ancker6, Jashvant Poeran3. 1Medical Education. 3,4Population Health Science and Policy, 5Medicine. 1,3,5Icahn School of Medicine at Mount Sinai, New York, NY, 2,4Weill Cornell Medical College, New York, NY, 6Vanderbilt University Medical Center, Nashville, TN. BACKGROUND: The COVID-19 pandemic necessitated a rapid roll-out of telemedicine in primary care practices nationwide, often requiring refinement and evolution, i.e., ‘maturation.’ Understanding this maturation process across practices is crucial to monitoring equitable care delivery. Here, we present preliminary results from a study – funded by the Patient-Centered Outcomes Research Institute – that aims to identify common themes of the telemedicine maturation process.

METHODS: After IRB approval, primary care practice leaders were identified at four participating health systems to undergo semi-structured interviews on their practices’ telemedicine program. A survey was developed by 1) applying health information technology evaluation frameworks, 2) scoping available evidence on telemedicine facilitators and barriers, and 3) using multiple rounds of feedback from various stakeholders. Respondents identified the month at which their practices’ telemedicine program reached a point of maturation. Quantitative and qualitative analyses compared telemedicine programs at the onset of the pandemic to the reported point of maturation.

RESULTS: Currently, 29 practice leaders have been interviewed representing 88 primary care practices across 4 states. Maturation of telemedicine programs was generally described to occur fairly early in the pandemic (50% within 2 months, 79% within 4 months). Program maturation was mostly reported in terms of logistically facilitating telemedicine visits (e.g., telephone calls ahead of visits, more efficient scheduling, documentation, billing, and reimbursement processes [20-48%]), integration of interpreter services (29%), increased patient access to telemedicine (34%), and decreased disparities in access (24%). Importantly, features not associated with telemedicine maturation included telemedicine modality (e.g., audio/video versus audio-only), use of patient portals to access telemedicine, telemedicine during non-traditional office hours, and provider training. Qualitative analyses identified differences based upon age of the telemedicine program.

CONCLUSIONS: Maturation of telemedicine programs throughout the pandemic was observed in areas relating to software evolution, population upgrades in telecommunication infrastructure, and operational processes. Future telemedicine programs should focus on these key areas in their deployment to accelerate the achievement of a maturation state.

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ABSTRACT 24 ECONOMIC ANALYSIS OF MRI AND PHYSICAL THERAPY REIMBURSEMENT IN ACL RECONSTRUCTION. Brennan Chu1, Justin Tiao2, Alexis Colvin2. 1Medical Education, 2Orthopaedics.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: ACL reconstruction (ACLR) is one of the most performed orthopedic procedures in the US. Despite the significance of ACLR, the economic burden it places on patients has been under-researched.

Apart from the cost of surgery, patients have ancillary costs such as magnetic resonance imaging (MRI) and physical therapy (PT). These costs are largely unknown and make it difficult for physicians to guide patients on their financial responsibilities.

OBJECTIVE: The purpose of this study is to quantify patient responsibilities for the major ancillary costs associated with ACLR, namely MRI and PT. METHODS: This study was done on patients who had undergone outpatient arthroscopic ACLR in the U.S. from 2013 to 2017 using the IBM MarketScan Commercial Claims and Encounters Database. Patients who had Current Procedural Terminology (CPT) code 29888 were included. MRI and post-operative PT reimbursement were identified using revenue codes and CPT codes. All values were inflation adjusted to 2017 dollars. Descriptive statistics were calculated and Spearman rank-order correlation was done to quantify trends over time.

RESULTS: In 2013, patient payments accounted for 15.4% of MRI reimbursement and 16.0% of physical therapy reimbursement. By 2017, this had increased to 35.4% for MRI reimbursement and decreased to 9.8% for physical therapy reimbursement. Spearman coefficients for MRI reimbursement demonstrated a decreasing trend for total reimbursement (rho = -0.115, p < 0.001) and an increasing trend in patient payments (rho = 0.063, p < 0.001). For physical therapy, an increasing trend for total reimbursement (rho = 0.069, p = 0.012) with a decreasing trend for patient payments (rho = -0.030, p < 0.001) was noted.

CONCLUSIONS: From 2013-2017, total MRI reimbursements have decreased while patient payments for MRI have increased during the same period. In comparison, total PT payments have increased while the patient portion of this payment has decreased. This could be influenced by changes in insurance payment procedures, namely increasing deductibles. Since MRIs are done preoperatively, patients have little likelihood of meeting their deductible prior to their scans, while postoperative PT patient costs are potentially allayed by patients having met their deductibles in their preceding care. Thus, in the future, there may be potentially increased patient cost-consciousness to preoperative rather than postoperative costs with rising deductible payments.

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ABSTRACT 25 PARENTAL EMPOWERMENT AND EFFICACY AMONG FOOD INSECURE FAMILIES AT A PEDIATRIC PRACTICE IN EAST HARLEM, NEW YORK CITY. Paige Cloonan1, Sonia Khurana1, Leora Mogilner2, Jennifer Acevedo2, Chris Gennings3, Shachi Mistry3, Stephanie Wu2, Eve Spear4, Arthi Vickneswaramoorthy2, Eden Alin5, Jenna Wisch6, Lauren Zajac2.

1 Medical Education, 2,4,5,6Pediatrics, 3Population Health Science and Policy. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY, 4Barnard University, NY, NY, 5NYIT College of Osteopathic Medicine, Old Westbury, NY, 6Stanford University, Stanford, CA. BACKGROUND: Previous studies suggest parents’ feelings of efficacy to parent and to connect with resources, parental empowerment (PE), act as a protective factor for child well-being. However, the relationship between food insecurity (FI) and PE has not been well-studied. With the rise in FI and other unmet social needs during the COVID-19 pandemic, we aimed to explore these interactions to inform interventions to improve family wellbeing.

OBJECTIVE: To characterize PE in families screened by our social determinants of health (SDH) program and referred to our onsite food pantry.

METHODS: We screened families for SDH by phone or in-person prior to visits to a NYC pediatric clinic.

Those with FI (Hunger Vital Signs) were offered enrollment in a prospective study assessing impact of FI interventions on family health. Caregivers completed a self-administered survey, including the 18-item USDA Household Food Security Survey classifying food security as high, marginal, low, and very low. PE was measured by the Parent Empowerment and Efficacy Measure (PEEM), a 20-question validated tool examining caregivers’ efficacy to parent (11 questions, 110 points) and efficacy connect (9 questions, 90 points) with a maximum PEEM score of 200. Using univariate analyses and logistic regression, we explored baseline demographics and the relationship between FI and PEEM score.

RESULTS: From June-December 2021, 406 families were screened for SDH and 125 (31%) had FI and were offered enrollment; 48 of those (38%) enrolled. Enrolled caregivers had a median age of 31 years (IQR 26.5, 35]), 58% were unemployed, and spoke English (77%) or Spanish (23%). Enrolled children were Black (40%), Multiracial (15%), or Other (25%), and 85% had public insurance. 52% of families had low food security, 8% had very low security and 25% had marginal security. Caregivers’ median overall PEEM score was 173.5 / 200 (IQR [157.5, 188]), with 100.5 / 110 (IQR [89.5, 106]) for “efficacy to connect” subscale and 74.5 / 90 (IQR [67.5, 82.3]) for “efficacy to parent” subscale. Lower degrees of food security (signifying increased FI) were associated with lower PEEM scores (p=0.04).

CONCLUSIONS: Caregivers with greater FI had lower overall PE scores. The impact of the onsite pantry and SDH screening program are being evaluated to assess impact on FI and parental empowerment in our year-long follow-up study.

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ABSTRACT 26 ADDRESSING THE PSYCHOTROPIC MEDICATION SHORTAGE IN A LOW-INCOME COUNTRY. Janet Coleman-Belin1, Hannah Johnson2, Craig Katz3.

1 Medical Education, 3Psychiatry. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: War and violence overwhelmingly burdens low and middle-income countries (LMICs),1 heightening mental health needs in under-resourced settings. To begin to fill post-conflict “mental health gaps,” nurses, physician assistants, and midwives can be trained as mental health clinicians (MHCs). 2,3 Shifting prescriber responsibility, while useful, is limited by psychotropic medication shortages in lowresource settings.4 This project assessed factors contributing to the psychotropic medication shortage in one low-income country and identified practical solutions.

METHODS: Following informational interviews with 48 key informants, the researchers assessed the magnitude of need for psychotropic medications in this partner country, logistical and regulatory challenges associated with supplying psychotropic medications, associated costs, and possible funding sources.

Informants were identified using a snowball sampling recruitment method5 and included stakeholders in the government, MHCs, nonprofits, foundations, pharmaceutical manufacturers and distributors, finance experts, and other relevant professionals.

RESULTS: Epidemiologic data revealed that less than 1% of the population receives mental healthcare in the partner country. Based on this data, annual medication costs range from $350,000 to $700,000 a year.

Multiple factors are contributing to the psychotropic medication shortage in the country: loss of international support, government budget cuts, issues with short-dated medication donations, and the COVID-19 pandemic. Still, the country has a robust pathway for medication distribution.

CONCLUSIONS: After examining various remedies, including medication donation from generic manufacturers and grant funding, we concluded that the most sustainable approach is a public-private partnership (PPP)6 with a small U.S. distributor that specializes in the partner country’s region of the world.

Through a combination of medication donation, procurement and fundraising, and impact investment, partnering with this distributor could incentivize global health innovation for an otherwise neglected issue and, if successful, may serve as a model for other under-resourced settings.

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ABSTRACT 27 A PROPOSAL FOR SELECTING POTENTIALLY INAPPROPRIATE MEDICATIONS IN HOSPITALIZED ELDERLY TO ADDRESS IN ELECTRONIC HEALTH RECORD-BASED CROSSOVER RANDOMIZED CONTROLLED TRIAL. Yhan Colon Iban1, Mayuri Jain2, Rainier Soriano3, Jashvant Poeran2. 1Medical Education, 2 Population Health Science and Policy, 3Geriatrics and Palliative Medicine.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: It is estimated that 30-50% of hospitalized older adults are prescribed potentially inappropriate medications (PIMs). PIMs may lead to substantial patient harm due to the potential downstream outcomes such as inpatient falls and injury, delirium, readmissions, and increased length of stay leading to increased costs. Given the large number of PIMs that could be targeted by any intervention, it is essential to develop a systematic approach to reduce selection bias, subjectivity, and maximize the impact of an intervention. As such, the aim of the project was to establish a proposal for selecting PIMs in hospitalized elderly to address in an electronic health record-based crossover randomized controlled trial.

METHODS: We conducted a literature review and found over 11 explicit criteria that have been endorsed in different countries by different geriatric associations or organizations. Two explicit criteria that are most referenced are the AGS Beers Criteria and the screening tool of older people’s prescription (STOPP). To select our target medications, we employed a data driven selection process. We conducted a data query of EPIC data for all medications and doses prescribed during one week to hospitalized patients ≥ 65-years-old at all NYC Health + Hospitals. Inclusion criteria were applied to develop a list of 25 medications. This list was then presented to an interdisciplinary council, the NYC Health + Hospital System High Value Care Council (SHVCC). Council members voted on which 10 drugs should be targeted by an electronic health recordbased intervention to reduce the frequency of PIMs. Inclusion criteria: Medications prescribed to at least 20 patients during the one-week period were evaluated to see if they were included in either criterion. Using Geriatrics At Your Fingertips, the lowest recommended oral dose was identified for the identified drugs. The average and most frequently prescribed dose were compared to the lowest recommended oral dose to select 25 drugs with the largest discrepancies.

RESULTS: 340 medications were prescribed from 06/13/21 – 06/19/21 across 10 hospitals. 99 (29%) were prescribed to at least 20 patients. 53 (53%) were included in either the STOPP or Beers criteria. Of these, 25 drugs with the largest discrepancies between recommended dose and frequently prescribed dose were voted on by the SHVCC. The 10 drugs and their default doses with the most votes were ultimately selected to be implemented in a crossover RCT.

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ABSTRACT 28 EFFECT OF TRANSVERSUS ABDOMINAL PLANE BLOCK USING LIPOSOMAL BUPIVACAINE VERSUS STANDARD BUPIVACAINE FOR OPEN MYOMECTOMY: A PILOT RCT STUDY. Tyler D'Ovidio1, Matthew Sison2, Cynthia Mercedes2, Gabrielle Veilleux2, Jong Kim2, Andjela Pehar2, Daniel Katz2. 1Medical Education, 2Anesthesiology. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Bupivacaine is currently used as the standard local anesthetic in open myomectomies, administered via TAP block. Liposomal bupivacaine extends the half-life of bupivacaine, a quality which prolongs post-operative pain control.

OBJECTIVE: To determine whether the co-administration of liposomal bupivacaine with standard bupivacaine during open myomectomy would reduce opioid consumption post-op.

METHODS: 50 patients presenting for open myomectomy were enrolled in a double-blind controlled trial and assigned to one of two study arms using a randomization block method. Patients randomized to the control arm received a TAP block with bupivacaine while patients randomized to the experimental arm received liposomal bupivacaine plus bupivacaine. The primary endpoint was cumulative morphine milligram equivalents (MMEs) consumed at 72-hours post-op, calculated as the sum of all opioids consumed via CDC guidelines.

Secondary endpoints included cumulative MMEs consumed at 48- and 96-hours, overall benefit of analgesic score (OBAS) at 72-hours, quality of recovery (QoR) score at 48- and 72-hours, and area under the pain scale curve at 96-hours (AUC0-96). Normal distribution was checked via Shapiro-Wilk test, with parametric or nonparametric data compared via unpaired 2-sample T test or Mann-Whitney U test.

RESULTS: 50 patients consented to participate in the study; 3 patients withdrew consent prior to treatment, and 1 was withdrawn due to a secondary procedure within the follow-up window. 23 patients were included in the analysis in each treatment arm. There were no significant differences in demographics between the control or experimental arms (median age 37 in both arms, mean BMI 27.4 vs. 27.5, ASA I in 26.1% vs. 21.7%, ASA II in 60.9% vs. 73.9%, ASA III in 13.0% vs. 4.3%) or baseline QoR scores (137 vs. 136; Mann-Whitney U = 204.5, n1 = 21, n2 = 23, P = 0.384). There were no statistically significant differences in mean cumulative MMEs consumed at 48-, 72-, or 96-hours between the control and experimental arms. Finally, no significant differences in QoR scores, OBAS, or AUC0-96 were found at any time point.

CONCLUSIONS: No significant differences were detected between control and experimental arms for any endpoint investigated. The non-normal distributions found in the pilot data are consistent with the low accrual of this study. This affirms that higher enrollment is needed for adequate power to detect potential differences between the two arms.

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ABSTRACT 29 DISCOVERY OF A NOVEL, SELECTIVE AND POTENT EZH2 PROTEIN DEGRADER TO TARGET TRIPLE NEGATIVE BREAST CANCER. Brandon Dale1, Chris Anderson2, Kwang-Su Park2, H Ümit Kaniskan2, Xufen Yu2, Jian Jin2.

1 Medical Education, 2Pharmacology and Systems Therapeutics. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. EZH2 (enhancer of zeste homolog 2) is the main catalytic subunit of the polycomb repressive complex 2 (PRC2) that catalyzes methylation of histone H3K27. EZH2 is overexpressed in a broad spectrum of cancers including prostate, myeloma and lymphoma, and high expression correlates with poor prognosis. However, EZH2 inhibitors, which do not affect EZH2 protein levels, are ineffective at inhibiting growth of TNBC and other breast cancer cell lines with EZH2 overexpression even though they effectively inhibit the catalytic activity of EZH2/PRC2. It has also been shown that overexpression of EZH2 is a major driver for breast cancer development and progression, and knockdown of EZH2 inhibits proliferation of TNBC and other breast cancer cells. These results together suggest that EZH2 overexpression, but not the methyltransferase activity of EZH2, is critical for driving breast cancer progression. Bivalent inhibitor technologies such as PROTACs (proteolysis targeting chimeras) and hydrophobic tagging have been successfully applied to selective degradation of multiple protein targets. CRBN-recruiting (E7) and VHL-recruiting EZH2 (YM281) EZH2 targeting PROTACs have been reported, but do not show potent efficacy in targeting TNBC. Here, we characterize MS8815, a VHL-recruiting EZH2 degrader that we created. MS8815 displayed nanomolar efficacy at EZH2 degradation and potent in vitro effects on TNBC cell lines, no off-target interactions and utilized the canonical PROTAC mechanism of action. Based on these promising preliminary results, we report MS8815 as the best-in-class EZH2 PROTAC degrader that is able to efficiently degrade EZH2 and kill TNBC cells.

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ABSTRACT 30 CHARACTERIZING THE DISTINCT GENOMIC IMMUNE PROFILE OF VITILIGO IN LESIONAL AND NON-LESIONAL SKIN. Eden David1, Ester Del Duca2, Emma Guttman2. 1Medical Education, 2 Dermatology. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Vitiligo is a chronic autoimmune depigmentation disorder, brought on by the destruction and degradation of melanocytes, affecting up to 2% of the population. Currently, treatment is limited and, oftentimes, not effective, especially in widespread disease. Prior research has implicated Th1/IFN-γ and Th17 immune axis dysregulation in vitiligo pathogenesis. Recent emerging data in serum samples of patients with vitiligo have pointed to the potential contribution of upregulation of Th2-related immune genes in disease development/progression, but more data is necessary. Our study aims to establish a detailed translational profile of vitiligo skin.

METHODS: We analyzed lesional and non-lesional skin biopsies from 16 vitiligo patients and 10 age-matched healthy controls. RNA sequencing, RT-qPCR and immunohistochemistry were performed in order to measure inflammatory markers and assess correlation with clinical severity. Fold-change/FCH ≥2.0 and false discovery rate/FDR ≤0.05 to identify differentially expressed genes/DEGs. RESULTS: A principal component analysis/PCA based on RNA-seq data showed that while normal skin samples clustered together, lesional and non-lesional vitiligo skin partially overlapped and were completely separated from the controls. RNA-Seq data depicted a total of 3855 differentially expressed genes/DEGs in lesional skin (993 up- and 2862 down-regulated) and 3099 (693 up- and 2406 down-regulated) in nonlesional skin. We found upregulation of Th1 (CXCL9, CXCL10, CXCR1), Th2 (IL4, IL10, IL13, CCL13, CCL18) and Th17 (CXCL2, IL20, PI3, S100As) related markers in lesional and/or non-lesional vitiligo skin compared to controls. RT-qPCR analysis found significant upregulation of Th2-related genes (ie. IL13, CCL13, CCL18, CCL22, P<0.05) in lesional and/or non-lesional samples compared to controls, as well as MMP12, Th1 markers (ie. IFN-γ, CXCL9, CXCL10, STAT1 P<0.05), and Th17/Th22-related genes (ie. IL22, S100A7, S100A9, P<0.05).

CONCLUSIONS: To the best of our knowledge, this is the first study to utilize such a broad range of mechanistic tools to better characterize the distinct immune profile of lesional and non-lesional vitiligo skin.

Our data may expand the pathogenic model of vitiligo and present new potential candidates for therapeutic targeting.

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ABSTRACT 31 NON-INVASIVE MARKERS OF VENTRICULAR ARRHYTHMIA IN DEGENERATIVE MITRAL VALVE PROLAPSE. Navindra David1, Percy Boateng2, Ahmed El-Eshmawi2, David Adams2, Dimosthenis Pandis2.

1 Medical Education, 2Cardiovascular Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Patients with degenerative mitral prolapse (DMP) are at risk of sudden cardiac death (SCD) due to undiagnosed ventricular arrhythmia (VA), prior to the onset of left ventricular (LV) remodeling. Despite the low incidence of SCD (up to 3%) in this subset of patients, it is necessary to ascertain the relationship between DMR and potentially fatal LV electrophysiological and/or clinical changes to help improve risk stratification and early detection.

OBJECTIVE: We sought to identify deviations from normal surface EKG and standard echocardiography markers in DMP patients and assess their potential impact on developing VA and/or sudden cardiac arrest (SCA).

METHODS: Retrospective review of progressively captured chart data from consecutive DMP patients with significant MR referred for surgical consult to a quaternary mitral repair reference center between 01/2018 – 12/2020. Only first -time cardiovascular intervention cases with isolated DMP ± secondary tricuspid regurgitation were included; N= 204).

RESULTS: VA was found in 32.4% of the population while 2%, had at least one SCA episode. LV function was preserved in 71.1% while 33.8% were asymptomatic with preserved LV. The observed EKG patterns were 47.5% ST-T abnormalities, 33.8% infarct patterns, 11.3% non-specific ST-T (NS_ST-T) segment abnormalities and 2.5% repolarization abnormalities. NS_ST-T were more prevalent in VA patients (25.8% vs. 9.4%). T-wave abnormalities were noted in 43% of the population, of which 79.5% met infarct pattern criteria. Prolonged QTc (> 440msec) was observed in 36.3% of the cohort with significantly longer duration (458 vs. 414msec).

LV hypertrophy voltage criteria were met in 22.5% of patients, of which 39.1% had documented VA. In multivariable regression, bileaflet prolapse, increased pulse pressure, repolarization abnormalities and NS_ ST-T changes were independent predictors of ventricular arrhythmia.

CONCLUSIONS: More than one in three patients with degenerative mitral valve regurgitation exhibit abnormal conduction and recovery patterns on routine surface 12-lead EKG. Together with bileaflet prolapse, such non-invasive markers may be help identify individuals with chronic degenerative mitral prolapse atrisk of potentially fatal arrhythmic events and optimize surveillance and timely referral of otherwise low-risk, asymptomatic patients.

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ABSTRACT 32 COCHLEAR IMPLANTS ON SOCIAL MEDIA: A NATURAL LANGUAGE PROCESSING ANALYSIS OF THE ONLINE PERSPECTIVE. Calista Dominy1, Evan Kominsky2, Eleni Varelas2, Joshua Rosenberg2, Alfred Iloreta2, Aldo Londino2.

1 Medical Education, 2Otolaryngology. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Social media usage in medicine has increased over the past decade, with doctors, hospitals, and patients using various platforms. Natural language processing (NLP) can be used with social media data to analyze a topic’s online presence.

OBJECTIVE: The purpose of this study was to use a NLP algorithm to analyze how cochlear implant devices (CIs) are represented on social media.

METHODS: Twitter posts were pulled from May to August 2021 using Twitter’s application programming interface (API) based on the hashtag ‘#cochlearimplant’ as inclusion criteria. A natural language toolkit algorithm (VADER sentiment analysis algorithm) in python programming language was used to assign tone values to each post. Assessment of content was also performed using computational text analysis methods.

VADER defines tones on a scale of -1.0 to 1.0, with positive posts generally being accepted as those with a tone > 0.5 and negative posts with tone < -0.5.

RESULTS: 373 Tweets were collected and met inclusion criteria. The average NLP-assigned tone value was 0.39 +/- 0.38. 52.8% of posts were neutral, 45.3% positive, and 1.9% negative. Of the positive-toned Tweets, content was mainly focused on educational material about cochlear implants, organizations sharing patient stories who had experiences with CIs, or sharing new research in the field. The content of the negativetoned Tweets, although there were very few of them, focused on negative experiences people with cochlear implants have experienced in life. The neutral-toned Tweets were mostly focused on new research, new technological product developments, and professional organizations sharing either educational information or patient stories.

CONCLUSION: With greater than 97% of posts being classified as positive or neutral, this could point to the fact that the NLP algorithm has a relatively low threshold for rating cochlear implant-related social media posts. These tone results also indicate that Twitter is largely not a forum that people go to complain or speak negatively about cochlear implants. The devices instead receive a sizable percentage of positive discourse.

Twitter seems to mostly be used for factual-based content about cochlear implants, such as patient education, new research, and technology updates. This supports the use of Twitter as an educational outlet for cochlear implant patient information as well as a tool to globally share new cochlear implant research.

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ABSTRACT 33 PREVALENCE AND CLINICAL CONSEQUENCES OF GENETIC VARIANTS ASSOCIATED WITH FAMILIAL HYPERCHOLESTEROLEMIA AND LDL-C LOWERING IN A DIVERSE PATIENT POPULATION. Bethany Dubois1, Emily Soper2, Michael Turchin2, Gillian Belbin2, Eimear Kenny2, Noura Abul-Husn2. 1Medical Education, 2Genetics and Genomic Sciences.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Familial Hypercholesterolemia (FH) is an autosomal dominant condition caused by pathogenic variants in LDLR, APOB, or PCSK9, and is characterized by elevated low-density lipoprotein cholesterol (LDL-C) levels. The presence of an FH variant increases risk of atherosclerosis and coronary artery disease (CAD), but early and aggressive lipid-lowering can largely prevent these outcomes.

Additionally, loss-of-function (LOF) variants in APOB and PCSK9 are associated with reduced LDL-C levels and decreased risk of CAD. FH is prevalent in the US, but most studies have been limited to European populations. The BioMe Biobank contains exomic data for >30,000 Mount Sinai patients linked to de-identified electronic health record (EHR) data. The majority of BioMe participants self-identify as Hispanic/Latino (34%) or African/African American (22%), providing an opportunity to evaluate FH in a diverse population.

RESEARCH QUESTION: What is the prevalence and clinical effect of both FH and low-LDL-C variants in the ancestrally diverse BioMe Biobank?

METHODS: Pathogenicity in LDLR, APOB, and PCSK9 was defined by cross-referencing the clinical genetics database (ClinVar), annotating with variant effect predictor (VEP), and/or by manual review.

Severe hypercholesterolemia was defined as a maximum EHR-recorded LDL-C 190 mg/dL, and controls were defined as maximum LDL-C <160 mg/dL. Linear and logistic regression were used to evaluate associations with LDL-C levels and severe hypercholesterolemia, respectively, adjusting for age, sex, and genetic ancestry.

RESULTS: The overall prevalence of FH variants was 1:219, and of low-LDL-C variants 1:102. FH variants conferred an increase in maximum LDL-C of 53 mg/dL (95% CI 45 to 62; p=2.0x10-34) while low-LDL-C variants conferred a decrease in maximum LDL-C by 37 mg/dL (95% CI 43 to 31; p=1.3x10-37). FH variants were associated with increased odds of severe hypercholesterolemia (odds ratio (OR) 12.3; 95% CI 7.8, 19.4; p=4.7x10-27), and low-LDL-C variants with decreased odds of severe hypercholesterolemia (OR 0.18; 95% CI 0.04 to 0.48; p=3.4x10-3).

CONCLUSION: FH variant prevalence (1:219) in a highly diverse biobank was comparable to previous results from homogenous populations. FH variants were associated with increased LDL-C and 12-fold increased odds of severe hypercholesterolemia, while protective low-LDL-C variants were associated with lower LDL-C and reduced odds of severe hypercholesterolemia.

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ABSTRACT 34 NF2 MUTATION ASSOCIATED WITH ACCELERATED TIME TO RECURRENCE FOR OLDER PATIENTS WITH ATYPICAL MENINGIOMAS. Jonathan Dullea1, Danielle Chaluts2, Jack Rutland2, Corey Gill2, Vikram Vasan2, Yayoi Kinoshita3, Russell McBride3, Joshua Bederson2, Michael Donovan3, Robert Sebra4, Melissa Umphlett3, Raj Shrivastava2. 1Medical Education, 2Neurosurgery, 3Pathology, 4Genetics and Genomic Sciences.

1,2,3,4 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: From 2011 to 2015, there were an estimated 29,183 annual meningioma diagnoses in the United States. These tumors tend to occur more frequently in older adults, with the incidence rates increasing from 5.8/100,000 for adults 35-44 years old to 55.2/100,000 for individuals 85+ years of age.

Due to the increased risk of surgical management in older adults, there is a need to characterize the risk factors for aggressive disease course, which may prompt subsequent treatment. If the information gathered from a resected tumor predicts a future aggressive disease course, one could direct that patient towards more frequent monitoring or adjuvant treatment. Identifying recurrences early via enhanced surveillance or preventing them through adjuvant therapy could reduce the need for subsequent extensive operations.

Prevention of significant surgery is an imperative paradigm in older adults.

OBJECTIVE: To determine age-stratified relationships between tumor genomics and recurrence after resection of atypical meningiomas.

METHODS: We identified 137 primary and recurrent Grade II meningiomas from our existing meningioma genetic sequencing database. We then examined the differential distribution of genomic alterations in those older than 65 compared to younger. We performed an age stratified survival analysis using cox-regression to model recurrence for a mutation identified as differentially present.

RESULTS: In our cohort of 137 patients with grade II meningiomas, alterations in NF2 were present at a potentially higher rate in older adults compared to younger (37.8% in < 65 vs. 55.3% in > 65; p =0.075). There was no association between presence of NF2 and recurrence in the whole cohort (HR = 1.2 (0.692, 2.08); p = 0.517). In the age-stratified model for those less than 65-years-old, there was again no relationship (HR = 0.860 (0.418 – 1.77);p = 0.682). In Looking at the older age stratum, there is a relationship between NF2 and worsened survival outcomes (HR = 3.64 (1.125 – 11.811); p = 0.031). If further analysis supports the prognostic value of NF2 alterations in older adults, more aggressive adjuvant treatment or screening may be necessary to prevent and monitor for recurrence.

CONCLUSIONS: We found that mutations in NF2 were more common in older adults. Further, the presence of mutant NF2 was found to confer an increased risk of recurrence in older adults compared to younger adults.

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ABSTRACT 35 ANTI-INTEGRIN ɑVβ6 ANTIBODIES IN PATIENTS WITH IBD. Alexandra Dunn1, Jeremy Fischer1, Carmen Argmann2, Mayte Suarez-Farinas2, Alexandra Livanos3, Saurabh Mehandru3. 1Medical Education, 2Genetics and Genomic Sciences, 3Medicine.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Inflammatory bowel disease (IBD), consisting of Crohn’s Disease (CD) and Ulcerative Colitis (UC), is a chronic inflammatory disorder with increasing prevalence worldwide. While previous work has identified biomarkers predictive of CD, equivalent biomarkers in UC have been limited. Recently, autoantibodies against integrin αvβ6, an integrin expressed exclusively on epithelial cells with a role in maintaining epithelial barrier integrity, have been identified in a cohort of Japanese patients with UC. OBJECTIVE: Our aim was to characterize the prevalence of anti-integrin ɑvβ6 IgG antibodies (anti-αvβ6) in a cross-sectional cohort of patients at Mount Sinai Hospital and evaluate whether these correlated with disease characteristics in order to understand its role as a potential biomarker.

METHODS: Serum samples from patients in the Mount Sinai Crohn’s and Colitis Registry (n = 648), a crosssectional cohort of patients with UC (n=193), CD (n=310), or non-IBD controls (n=145), were analyzed for the presence of anti-αvβ6 using an ELISA. Nonparametric statistical tests were used to assess differences in anti-αvβ6 between disease groups and characteristics (i.e. disease severity, inflammatory markers).

RESULTS: Anti-integrin ɑvβ6 antibodies were present in a higher proportion of both UC (74%) and CD (22%) as compared to controls (p<.0001, p<.0001, respectively). UC patients had higher anti-ɑvβ6 compared to CD (p<.0001) and controls (p<.0001). ROC analyses revealed AUC of 0.914 for UC vs. control, 0.605 for CD vs. control, and 0.822 for UC vs. CD. Using a cut off of 0.833, the sensitivity and specificity for UC vs. control was 74% and 94%, respectively; the sensitivity and specificity for UC vs. CD was 74% and 78%, respectively.

Further, there was a significant positive correlation between anti-αvβ6 levels and UC disease severity (Mayo score, p<.0001, Spearman r=.32). Anti-ɑvβ6 antibodies did not correlate with disease activity for CD patients (SES-CD), nor did they correlate with disease behavior or location.

CONCLUSIONS: Anti-ɑvβ6 antibodies, a novel biomarker for UC, can potentially be used for disease activity monitoring. Our ongoing work aims to identify the mechanisms by which anti-ɑvβ6 antibodies induce intestinal inflammation.

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ABSTRACT 36 DISPARITIES IN MATERNAL HEALTH OUTCOMES FOLLOWING CHILDBIRTH IN NEW YORK CITY: AN EQUITY ANALYSIS. Annalise Eger1, Toni Stern2. 1Medical Education, 2Obstetrics, Gynecology, and Reproductive Science. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Disparities in pregnancy health outcomes among Americans have been the subject of much popular press and academic research in the last decade. Research has shown that non-white birthing people and babies have a far higher risk of morbidity and mortality compared to white parents, with Black patients at highest risk. These differences in childbirth outcomes by race persist even when comorbidities are accounted for.

HYPOTHESES: 1. Non-white patients will have longer length of stay following childbirth.

2. Non-white patients are more likely to deliver via C-section than white patients.

3. Non-white patients are more likely to be readmitted to the hospital following childbirth than white patients.

4. Non-white labor and delivery patients will rate hospital care and attention less highly than white patients.

METHODS: Data from EPIC has been aggregated by the Mt. Sinai Ob/Gyn Department and includes delivery type (C-section or vaginal), readmissions, length of stay, and measures of patient satisfaction. It also includes patient race/ethnicity, type of insurance (commercial, Medicare/Medicaid, or other), BMI, age, and history of hypertension or hemorrhage. Data from 2019-2021 obstetrics patients was used in this study (N=30,006).

Statistical analyses were performed using the data to examine the above hypotheses. Logistic regression was used for hypotheses 2 and 3, while linear regression was used for hypotheses 1 and 4.

RESULTS: Even after controlling for insurance type, age, BMI, hypertension, & hemorrhage, non-white patients stayed an average of 1.6 (95% CI: 1.442-1.757) days longer in the hospital following childbirth than white patients. Non-white patients had 1.702 (95% CI: 1.541-1.880) times the odds of delivering via C-section than white patients. Non-white patients had 2.113 (95% CI: 1.350-3.308) the odds of being readmitted to the hospital following giving birth than white patients. Finally, non-white patients answered an average of 0.349 (95% CI: 0.085-0.612) more questions about their satisfaction with top marks than white patients.

CONCLUSIONS: Non-white patients were significantly more likely to deliver via C-section or be readmitted to the hospital compared to white patients and stayed significantly longer following birth. However, Black and Hispanic patients rated satisfaction more highly than white patients. These disparities warrant intervention and are likely impacted to some extent by care provider bias.

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ABSTRACT 37 ASSOCIATIONS AMONG PRENATAL EXPOSURE TO METALS AND THEIR MIXTURE AND INFANT NEGATIVE AFFECTIVITY: EXPLORING EFFECT MODIFICATION BY PRENATAL CORTISOL AND FETAL SEX. Samuel Eitenbichler1, Francheska Merced-Nieves2, Rosalind Wright2. 1Medical Education, 2 Pediatrics. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Pregnant women in lower-income communities disproportionately experience co-occurring environmental hazards that impact fetal neurodevelopment including metals (As, Ba, Cd, Cs, Cr, Pb, and Sb) and psychosocial stress. Metals and stress impact maternal-fetal hypothalamic-pituitary-adrenal (HPA) axis functioning, a key stress-response system indexed by cortisol production. These co-occurring in utero exposures interact in complex ways to influence development. Sex-specific effects are also reported.

OBJECTIVE: We examined joint associations between prenatal exposure to a metal mixture, third trimester cortisol, and child sex with infant negative affect, a stable temperamental trait that predicts long-term behavioral functioning. We hypothesized that the effect of the metal mixture on negative affect would be enhanced by increased cortisol in a sex-specific manner.

METHODS: Analyses included n=266 mother-infant pairs from the longitudinal Programming of Intergenerational Stress Mechanisms (PRISM) pregnancy cohort with complete data on prenatal urine metals, third trimester hair cortisol, infant negative affect assessed using the Infant Behavior QuestionnaireRevised (IBQ-R) completed when infants were aged 6 months. Outcomes included the global measure of negative affect and four sub-domains – Fear, Sadness, Distress to Limitations, and Falling Reactivity. Weighted Quantile Sum (WQS) regression with repeated holdout validation was used to investigate joint associations among the prenatal metal mixture, cortisol, and fetal sex in relation to each negative affect parameter.

Modifying effects of prenatal cortisol and fetal sex were examined using 2- and 3-way interactions.

RESULTS: Significant 3-way interactions were demonstrated with four of the five IBQ-R parameters: negative affectivity, fear, sadness, and falling reactivity. Specifically, girls born to mothers with higher cortisol had significantly higher scores of negative affectivity (β=0.19; 95% CI: 0.27, 0.11), fear (β=0.80; 95% CI: 0.91, 0.69), and sadness (β=0.24, 95% CI: 0.32, 0.16) with greater exposure to the metal mixture.

CONCLUSION: These findings underscore the need to examine higher-order interactions between measures of chemical and non-chemical environmental stressors with host factors including sex to identify those children most at risk for neurobehavioral disorders as early in development as possible in order to design interventions that optimize child development.

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ABSTRACT 38 POPULATION-BASED PENETRANCE OF DELETERIOUS CLINICAL VARIANTS. Iain Forrest1, Kumardeep Chaudhary2, Ha My Vy2, Ben Petrazzini2, Shantanu Bafna2, Daniel Jordan2, Ghislain Rocheleau2, Ruth Loos2, Girish Nadkarni3, Judy Cho3, Ron Do2. 1Medical Education, 2 Genetics and Genomic Sciences, 3Medicine. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. IMPORTANCE: Population-based assessment of disease risk associated with gene variants informs clinical decisions and risk stratification approaches.

OBJECTIVE: To evaluate the population-based disease risk of clinical variants in known diseasepredisposition genes.

METHODS: This cohort study included 72,434 individuals with 37,780 clinical variants who were enrolled in the BioMe Biobank from 2007 onwards with follow-up until December 2020 and UK Biobank from 2006-2010 with follow-up until June 2020. Participants had linked exome and electronic health record data, were older than 20 years of age, and were of diverse ancestral backgrounds. Exposure: Variants previously reported as pathogenic or predicted to cause a loss of protein function by bioinformatic algorithms (pathogenic/LoF variants). Main Outcomes and Measures: The primary outcome was the disease risk associated with clinical variants. The risk difference (RD) between the proportion of disease in individuals with a variant allele (penetrance) versus individuals with a normal allele was measured.

RESULTS: Among 72,434 study participants, 43,395 were from the UK Biobank (mean [SD] age, 57 [8.0] years; 55% female; 7% non-European) and 29,039 were from the BioMe Biobank (mean [SD] age, 56 [16] years; 60% female; 68% non-European). Of 5,360 pathogenic/LoF variants, 4,795 (89%) were associated with RD ≤0.05. Mean penetrance was 6.9% (95% CI, 6.0-7.8%) for pathogenic variants and 0.85% (95% CI, 0.76-0.95%) for benign variants reported in ClinVar (difference=6.0 percentage points, 95% CI, 5.66.4 percentage points) with a median of 0% (IQR=0%) for both groups due to large numbers of nonpenetrant variants. Penetrance of pathogenic/LoF variants for late onset diseases was modified by age: mean penetrance was 10.3% (95% CI, 9.0-11.6%) in ≥70-year-old individuals and 8.5% (95% CI, 7.9-9.1%) in ≥20-year-old individuals (difference=1.8 percentage points; 95% CI, 0.40-3.3 percentage points). Penetrance of pathogenic/LoF variants was heterogeneous even in known disease-predisposition genes, including BRCA1 (mean [range], 38% [0-100%]), BRCA2 (38% [0-100%]), and PALB2 (26% [0-100%]).

CONCLUSIONS AND RELEVANCE: In 2 large biobank cohorts, the estimated penetrance of pathogenic/ LoF variants was variable but generally low. Further research of population-based penetrance is needed to refine variant interpretation and management of individuals with these variants in the general population.

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ABSTRACT 39 CLINICAL AND DEMOGRAPHIC CHARACTERISTICS OF PATIENTS WITH COVID-19 BREAKTHROUGH INFECTIONS IN NEW YORK CITY. Miriam Frisch1, Gabriel Cohen2, Angelie Oberoi3, Leopolda Silvera3, Justin Chan3, Vikramjit Mukherjee3, Kenra Ford3, Joseph Masci7. 1Medical Education, 2,4,7Medicine. 1,7Icahn School of Medicine at Mount Sinai, New York, NY, 2Bellevue Hospital, NYC H+H, NY, 3NYC H+H, NY. BACKGROUND: Despite viral evolution of SARS-CoV-2 and the emergence of Delta variant, vaccines continue to be highly protective against serious Covid-19 infection and related mortality. Breakthrough infections, defined as new cases among individuals fully vaccinated at time of test, have been documented, though cases are largely asymptomatic or mildly symptomatic. However, there has been limited large-scale analysis of the prevalence of breakthrough infections among hospitalized patients. Throughout the New York City Health and Hospital (NYC H+H) network, breakthrough infections have been surveilled in inpatient and outpatient settings. In this study, we aimed to describe the demographics and frequency of hospitalization of breakthrough infections within the NYC H+H system.

METHODS: From January 1– July 31, 2021, 1,440 fully vaccinated patients infected with Covid-19 were identified as breakthrough cases within the NYC H+H system, across outpatient, emergency department, and inpatient settings. De-identified demographic (age, race, sex, zip code) and clinical data (symptoms at time of test, vaccination date and type, hospitalization status, primary diagnosis, and ICU admission) were extracted from electronic medical records. Data was analyzed using aggregated statistics.

RESULTS: Breakthrough cases were found to be evenly distributed by gender with a median age of 45.

Geographically, cases were concentrated in the boroughs of Brooklyn and Queens. Most breakthrough infections were in individuals who had received the Pfizer-BioNTech vaccine (57.6%) and occurred a median time of 54 days after full vaccination. The majority of infections (93%) were identified in outpatient settings, with 87% of those symptomatic at time of test. Of the 7% of cases reported in inpatient settings, the majority were admitted for non-Covid-19 related illness. Upon discharge, 50% of inpatient breakthrough infections had a non-Covid-19 related primary diagnosis.

CONCLUSIONS: These findings are consistent with a growing understanding that breakthrough infections are largely mild or asymptomatic, occurring in younger patients. They also suggest that patients diagnosed within hospital settings are often diagnosed as part of routine screenings and are being admitted for nonCovid-19 related illness. Further study of hospitalized patients with breakthrough infections is needed to better understand the reason for admission in this group.

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ABSTRACT 40 INTRAVENOUS STEROIDS ARE NOT ASSOCIATED WITH BETTER OUTCOMES IN PATIENTS WITH CROHN’S DISEASE HOSPITALIZED FOR AN ACUTE BOWEL OBSTRUCTION. Mariely Garcia1, Jean-Frédéric Colombel2, Anketse Debebe3, Farhan Mahmood4, Sharon Nirenberg3, Alexa Rendon3, Jiani Xiang4, David Sachar2. 1Medical Education, 2Medicine, 3Genetics and Genomic Sciences. 1,2,3,4Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: IV steroids are recommended by most societies for the treatment of acute bowel obstruction (ABO) in patients with Crohn’s disease (CD). This common treatment, however, has not been subjected to rigorous systematic investigation and anecdotal evidence suggests that steroid treatment is unnecessary.

OBJECTIVE: To look at the efficacy of IV steroids in patients with CD who were hospitalized for an ABO in a tertiary referral center. Delineating if and when steroids provide benefit for ABO resolution will help reduce medical waste, limit adverse events associated with steroid use, and help providers better target their management.

METHODS: This was a retrospective study of CD patients ≥18 years old who were admitted for an uncomplicated ABO between 2011 and 2021 in our center. Efficacy endpoints were obtained from the Epic Clarity and Epic Caboodle databases and included need for surgery, length of hospitalization and mortality. Manual chart review was performed on randomly selected charts to ensure accuracy of the queries used for data extraction. Descriptive statistics were used to compare study groups.

RESULTS: Among 942 unique CD patients admitted for an ABO, 89 (9%) received IV steroids at admission and 853 did not. There was no significant difference in sex or disease duration between groups. We found that IV steroid administration did not lead to shorter hospital stays, decreased frequency of surgery, or decreased mortality - Surgery was needed in 3 (3%) patients and 32 (4%) patients in the steroid and no steroid group, respectively. Length of hospitalization was similar between both groups: 5.6 ± 4.88 days and 5.5 ± 6.11 days, respectively. No patients in the steroid group died during their hospitalization and only three patients expired in the no steroid group (<1%). We noted a significant difference in age between groups. However, we do not believe this difference changes our interpretation of the results - Older patients tend to have a worse prognosis and even though the steroid cohort was younger, they still did not do better with steroids.

CONCLUSIONS: Our findings suggest that the commonly recommended practice of administering steroids for ABO bears no benefit to patients over treatment without steroids. This brings into question the utility of such treatment. It is possible that steroids provide benefit to select patients but further work to identify and characterize this population, if it exists, needs to be done.

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ABSTRACT 41 MEDICAL STUDENT COMPREHENSION AND APPLICABILITY OF ADVERSE CHILDHOOD EXPERIENCES TRAINING. Jennifer Gates1, Tomas Restrepo Palacio2, Kyle Gibson1, Arifa Zaidi3, Susan Kim4, Timothy Rice2.

1 Medical Education, 2Psychiatry. 1,2Icahn School of Medicine at Mount Sinai, New York, NY, 3 New York University, New York, NY, 4 Massachusetts General Hospital, Boston, MA. BACKGROUND: Exposure to Adverse Childhood Experiences (ACEs) is associated with lifetime worsened physical and behavioral health outcomes. Trauma history can arise in many clinical settings, and it is important for physicians of all disciplines to feel comfortable screening their patients for ACEs. Medical students and physicians may have decreased comfort in asking these questions relative to specialists. A digital training may address this gap and demonstrate acceptability to trainees and non-specialists as well as offer feasibility in dissemination. To date, there are no studies investigating whether a digital board game could be an effective modality to educate these populations about ACES. OBJECTIVE: A learning session and virtual game about ACEs may increase medical students’ self-reported understanding of ACEs and their comfort in discussing these topics with patients. We will evaluate prior education on trauma and comfort in discussing ACEs both pre- and post-game.

METHODS: A 90-minute training course utilizing a digitized board game about ACEs was presented to students, and they were asked to complete a self-report questionnaire before and after the session with 6 questions on a 5-point Likert scale concerning prior education on trauma (q.1), comfort in discussing trauma with patients (q. 5), ability to identify effective interventions (q.6), and other aspects related to ACE exposure. Differences in response scores between pre- and post-training survey were analyzed via t-test and independent Mann-Whitney U test. A composite score for the five items was computed and correlated with the prior education (q.1) via the Pearson correlation.

RESULTS & CONCLUSIONS: Scores for “I have been educated about trauma” were significantly (p<.001) greater in the post-training group. There were no significant differences between pre- and post-exposure groups for other statements. A significant (p<.001) correlation (r=.796) was found between “I have been educated about trauma” and the aggregate score.

Limitations include the small sample size which may fail to identify other significant associations. General knowledge and training about trauma informs future clinicians' understanding, while this specific board game can exist as a tool to provide such training. Future directions include implementing this training with other cohorts, assessing feasibility of dissemination, and comparing the efficacy of this tool to others.

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ABSTRACT 42 A COMMUNITY-ACADEMIC PARTNERSHIP TO CREATE AN ONSITE FOOD PANTRY IN A PEDIATRIC CLINIC TO ADDRESS FOOD INSECURITY IN THE ERA OF COVID-19.

Alioune Gaye1, Lauren Zajac2. 1Medical Education, 2Environmental Medicine & Public Health.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Since 2017, a social determinants of health (SDH) screening and referral program at a New York City pediatric clinic has referred families with food insecurity (FI) to a community pantry (New York Common Pantry-NYCP) for food assistance and enrollment in means-tested benefits such as SNAP and WIC. A 2019 follow up study showed that only 9% of NYCP referrals were completed due to barriers such as lack of childcare, work obligations, and transportation. Given the dramatic rise of FI during the pandemic and the barriers to referral completion identified previously, we partnered with NYCP to establish an on-site food pantry in the clinic.

OBJECTIVE: Explore the feasibility of a community-partnered onsite food pantry to provide immediate assistance to families with FI. METHODS: With grants and donations, we created a program whereby NYCP delivered 25 food packages weekly (each with 12 meals for a family of 4). NYCP provided an onsite case manager once a week for 4 weeks to assist with referrals while the clinic team was trained. Families were screened with the existing SDH screening tool in the electronic medical record, and families with FI (using Hunger Vital Signs) were given a food package and offered enrollment in NYCP. Families who declined NYCP referral were provided a list of food pantries in their borough. Using informant interviews, feedback was solicited from clinic social workers, house staff, and attendings to improve the FI screening and referral process.

RESULTS: From October-December 2020, 250 food packages were distributed to families with FI. Of those,103 families (41.2%) agreed to become clients of NYCP where they will receive food packages on a bi-weekly basis and be assessed for eligibility for means-tested benefits. Physicians felt the screening and referral process was easy to accomplish during a busy clinical encounter and the program was well-received by families. Clinic staff members commented that families were excited by the presence of an onsite pantry and pleased with the amount of food and quality of the packages.

CONCLUSIONS: The onsite pantry, a successful community-academic partnership, provides immediate assistance to families with FI and reduces some of the logistical barriers to referral completion identified in our previous study. Future work will assess the impact of this program on FI status, long-term participation in NYCP services, and enrollment in means-tested benefits.

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ABSTRACT 43 THE ASSOCIATION BETWEEN UV-RELATED DERMATOLOGICAL CARCINOMAS AND EXFOLIATION SYNDROME AND EXFOLIATION GLAUCOMA: A CLINIC-BASED STUDY. Jack Geduldig1, Jeff Huang2, Louis Pasquale2. 1Medical Education, 2Ophthalmology.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Exfoliation Syndrome (XFS) is a typically asymmetric, age-related ocular disease that manifests when white extracellular fibrillar material deposits on the anterior lens capsule and portions of the anterior segment of the eye. XFS can lead to exfoliation glaucoma (XFG), the most common form of secondary open-angle glaucoma and most identifiable form of glaucoma.

OBJECTIVE: Our goal is to explore whether excess ocular UV exposure is associated with XFS with or without XFG. As a proxy for significant lifetime ocular UV exposure, we aim to assess if there is excess basal cell carcinoma (BCC) and/or squamous cell carcinoma (SCC) in patients with XFS/XFG, and if an increasing number of BCC/SCC lesions at specific locations on the body increased the risk of developing XFS/XFG. METHODS: Since lifetime ocular exposure to UV radiation is difficult to quantify, we considered a history BCC/SCC and the relation to XFS/XFG in a clinic-based population. A total of 321 patients were included (52.6% female, 96.2% white ethnicity) – 98 with XFS/XFG, 117 with POAG (primary open-angle glaucoma, a form of glaucoma without anterior segment fibrillar deposits) and 106 controls. Patients were administered a survey about past medical and ocular history. Binary logistic regression analyzed if the presence of BCC/SCC increased the odds of XFS/XFG. All BCC/SCC lesions, those specific to the head/neck, and the number of lesions broken into ordinal variable groups were studied. The covariates in the analysis included patient age, sex, ethnicity, family glaucoma history, hypertension, diabetes, sleep apnea, atrial fibrillation, cardiovascular disease, eye color, hair color (age 18), and the likelihood of tanning or burning as a child.

RESULTS: The presence of any BCC/SCC was not associated with increased odds of XFS/XFG (OR=1.65, 95% CI:0.88-3.09). The presence BCC/SCC localized to the head and neck region was associated with increased odds of XFS/XFG (OR=2.01, 95% CI:1.04-3.87). An increasing number of head and neck BCC/SCC lesions grouped into zero, 1, or 2+ lesions was associated with increased odds of XFS/XFG (OR=1.67, 95% CI:1.09-2.56).

CONCLUSION: When using BCC/SCC as a proxy for lifetime UV radiation exposure, both exposure and degree of exposure to UV radiation localized to the head and neck increases the odds of developing XFS/ XFG. This study supports a public health message about wearing UV protective eyewear in addition to regular ophthalmologic evaluations.

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ABSTRACT 44 THE EXPERIENCES OF ASYLUM SEEKERS TO THE UNITED STATES DURING THE COVID-19 PANDEMIC. Mahalya Gogerly-Moragoda1, Kevin Molyneux2, Dustin Kee1, Kim Baranowski3, Elizabeth Singer2.

1 Medical Education, 2Emergency Medicine, 3Psychiatry. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: The spread of the novel coronavirus SARS-CoV-2 (COVID-19) has resulted in a global pandemic which has profoundly impacted the health and wellbeing of communities. Significant barriers to accessing healthcare and social services which asylum seekers to the United States previously faced were exacerbated by the pandemic and increased this population’s vulnerability to deleterious outcome. More information is needed to better understand asylum seekers’ experiences as a result of COVID-19.

OBJECTIVE: To uncover the impact of the first year of the COVID-19 pandemic on asylum seekers to the United States, including social and economic stressors and their access to medical information, healthcare, and testing.

METHOD: We conducted 15 semi-structured, in-depth interviews with adult asylum seekers to the U.S. and systematically analyzed the resulting transcripts using a consensual qualitative research approach. Transcript data was organized into larger themes/domains, and text from domains were then summarized into a series of nuanced core ideas. Categories developed from core ideas described similarities found between participants and elucidated needs and patterns of health disparities in the population.

RESULTS: The transcripts yielded six domains: (1) knowledge and understanding of COVID-19; (2) attitudes and practices relating to COVID-19 precautions; (3) experience of COVID-19 symptoms; (4) current physical and mental health; (5) access to and interaction with health care; (6) discrimination based on asylum status.

Although participants had knowledge about COVID-19’s communicability and regularly used masks, their living conditions frequently hindered their ability to quarantine and isolate and their lack of insurance was often a deterrent to them seeking medical care. Notably, immigration status was not a factor discouraging participants from seeking care during the pandemic.

CONCLUSION: This study gathered first person narratives of asylum seekers to the U.S. revealing their unique experiences during the COVID-19 pandemic. The findings build on existing knowledge about this community and may help define areas where support and services can be expanded in the current and future pandemics, particularly in the realms of access to health insurance and flexible housing.

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ABSTRACT 45 GENERATING NOVEL ENDOCRINE DATASETS FROM OPEN SOURCE DATA AND ANATOMICAL PRIORS. Rachel Gologorsky1, Edward Harake2, Grace von Oiste3, Mustafa Nasir-Moin4, William Couldwell5, Todd Hollon6, Eric Oermann4. 1Medical Education. 4,5,6Neurosurgery. 1Icahn School of Medicine at Mount Sinai, New York, NY, 2University of Michigan Medical School, Ann Arbor, MI 48109, 3Harvard University, Cambridge, MA 02138, 4New York University Langone Medical Center, New York, NY 10016, 5 University of Utah, Salt Lake City, UT 84132, 6University of Michigan, Ann Arbor, MI 48109.

BACKGROUND: The incidence of pituitary adenomas in the general population is 10-30%, yet radiographic diagnosis remains a challenge. Diagnosis is complicated by heterogeneity of radiographic features in both normal (e.g., complex anatomy, pregnancy, puberty) and pituitary pathology (e.g., primary endocrinopathy, hypophysitis, non-adenoma neoplasms), particularly when clinical symptoms and laboratory results are equivocal. Although computer vision models can conceivably aid in diagnosis, no dedicated pituitary imaging dataset exists to train such models.

HYPOTHESIS: A novel pituitary imaging dataset could be generated by training machine learning models to extract the pituitary region from open-source whole-brain MRIs. METHODS: Six open-source whole-brain MRI datasets relating to autism, stroke, Parkinson’s, Alzheimer’s, and brain mapping were identified and repurposed. 333 scans from the autism dataset were annotated for the pituitary region: 201 scans (60%) were used for model training, 66 scans (20%) were used for model validation, and 66 scans (20%) were held-out and used as a test set for evaluating model performance. 418 annotated scans from the other datasets were used to test model performance on out-of-distribution data.

Model performance was evaluated on the basis of Dice score (F1 score), a measure of the overlap between the model's predicted pituitary region and the manually annotated pituitary region. Six model architectures were evaluated.

RESULTS: A large pituitary dataset of 6,755 scans was algorithmically generated. Final ensemble algorithm achieves Dice scores ranging from .76 to .82 across the component datasets. Reproducibility: across 10 independent re-trainings, the average Dice score on the combined test set was 0.796 ± 0.064.

CONCLUSIONS: The presented algorithm is robust to distribution shifts, generalizes well across patient population/health systems, and could be used to extract the pituitary region from any future whole-brain MRIs. This pioneering pituitary imaging dataset provides both clinicians and researchers with a reference of “normal” pituitaries. This concept could be applied to create population-scale imaging datasets of other small/difficult to visualize substructures.

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ABSTRACT 46 ORAL MICROBIOME COMPOSITION OF PEANUT ALLERGIC CHILDREN WITH LOW VERSUS HIGH SENSITIZATION TO PEANUT. Miguel Gomez1, Yoojin Chun2, Hsi-en Ho2, Supinda Bunyavanich2. 1Medical Education, 2 Pediatrics. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Peanut allergy accounts for a large share of food allergies in the population. Disruption of the gastrointestinal (GI) tract microbiome may be an important factor in food allergies. A prior study demonstrated oral microbial differences among children with and without peanut allergies. Children with peanut allergies have varying peanut specific IgE (sIgE) levels. Not much is known about whether oral microbiota play a role in sensitization.

HYPOTHESIS: There are differences in oral microbial composition between peanut allergic children with low versus high levels of sensitization to peanut.

STUDY METHODS: Peanut allergic children aged 4-25 years enrolled in a multidimensional study of the oral microbiome (n=56) were categorized into a low sensitization group (peanut serum sIgE≤ 15 KUA/L) or a high sensitization group (peanut sIgE>15 KUA/L). Saliva samples were collected by having each subject hang their head and allowing saliva to drip into collection tubes. DNA was extracted from the saliva and analyzed via 16S rRNA sequencing (Illumina). Alpha diversity analyses were performed using Qiime2, and LEfSe (Linear discriminant analysis Effect Size) was used to identify microbial species. Regression analyses were done using glm function in R. RESULTS: The mean age of the 54 subjects was 10.9 years (SD = 4.8) and 31% of subjects were female. The low sensitization group (n=17) had a mean peanut sIgE level of 4.8 kUA/L (SD= 3.8), and the high sensitization group (n=37) had a mean peanut sIgE of 73.8 kU/L (SD= 31.2). Twenty nine (54%) children had asthma.

Logistic regression models adjusted for asthma showed that bacterial alpha diversity (Shannon index) was higher in the low sensitization group (beta coefficient = 1.96, p-value = 0.048). Peanut allergic individuals with low sensitization had increased abundance of Lautropia sp. (LDA = 3.5, p-value = 0.035), Leptotrichiaceae sp.

(LDA = 3.2, p-value = 0.0087), Absconditabacteriales sp. (LDA = 2.9, p-value = 0.048) and Aggregatibacter sp. (LDA = 2.8, p-value = 0.037). Those with high sensitization had increased Prevotella sp. (LDA = 3.2, p-value = 0.046) and Saccharimonadaceae sp. (LDA = 2.2, p-value = 0.049).

CONCLUSIONS: This study indicates that oral microbiome composition differs between peanut allergic subjects with high vs. low peanut sIgE levels. A future study should be done to determine how these bacteria potentially cause peanut sIgE to differ between children.

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ABSTRACT 47 A SYSTEMATIC REVIEW OF DIGITAL INTERVENTIONS TO IMPROVE ART ADHERENCE AMONG YOUTH LIVING WITH HIV IN SUB-SAHARAN AFRICA. Kevin Griffee1, Roxanne Martin2, Ashley Chory2, Rachel Vreeman2. 1Medical Education, 2 Arnhold Institute for Global Health. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: More than 30% of new HIV infections occur among youth, and more than 80% of youth living with HIV (YLHIV) reside in sub-Saharan Africa (SSA). YLHIV generally maintain lower ART adherence levels compared to other age groups.

OBJECTIVE: Given expanding youth mobile phone ownership, this review systematically assessed whether digital interventions can improve YLHIV ART adherence in SSA. METHODS: PRISMA 2020 guidelines were followed. PubMed and SCOPUS databases were searched using adherence, Africa, ART or ARV, HIV or AIDS, adolescent* or teen* or young adult, and computer or digital or ehealth or electronic or Facebook or gaming or laptop or mhealth or mobile or phone or SMS or social media or tele* or text messag* or video or WhatsApp or wireless. Two researchers (KG, RM) screened articles, and a third researcher (AC) resolved conflicts. Experimental or quasi-experimental studies in SSA evaluating the quantitative effect of digital interventions on YLHIV (aged 15-24 years) ART adherence were included.

RESULTS: 3849 titles and abstracts, and 122 full-texts were screened. Data were extracted from six articles published between 2017-2021. Interventions lasted 20-96 weeks and took place in Kenya, Nigeria, Uganda, and Zimbabwe. Two studies found significant intervention-related improvements in viral suppression.

One study used SMS for appointment and daily adherence reminders. The other combined weekly SMS reminders with support groups, home visits, phone calls, and counseling. A third study (not designed to test for significance) suggested adherence improved when YLHIV received texted feedback on individual adherence alongside peer adherence levels. The final three studies, using SMS, Facebook, and web-based peer support programs, did not significantly improve adherence. Of the adherence measurements utilized across included studies, only viral load – and not self-report, pill counts, or medication event monitoring systems (MEMS) – changed significantly post-intervention.

CONCLUSIONS: This review provides mixed support for digital ART adherence interventions. Its findings contrast with studies in U.S. youth and adult SSA populations, which showed additional positive effects of SMS on non-viral load adherence measures, such as self-report. The recency of included studies reflects the novelty of digital adherence interventions for YLHIV in SSA. Further studies of digital interventions for YLHIV adherence are needed to assess their efficacy in these settings.

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ABSTRACT 48 OUTCOMES IN INFANTS BORN TO MOTHERS WITH AND WITHOUT NON-ALCOHOLIC FATTY LIVER DISEASE. Aliza Gross1, Rhoda Sperling2, Courtney Juliano3, Jaime Chu3, John Bucuvalas3, Tatyana Kushner4.

1 Medical Education, 2Obstetrics, Gynecology, and Reproductive Science, 3Pediatrics, 4Medicine.

1,2,3,4 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the US, affecting 20-30% of the general population and 10-15% of pregnant women. Several studies have shown that infants born to mothers with NAFLD have higher risk of complications, including preterm birth and increased weight for gestational age. However, there is limited data on long-term pediatric outcomes. We evaluated outcomes in infants born to mothers with NAFLD, compared to a control population of women without NAFLD. METHODS: Subjects were identified through an ongoing prospective study of pregnant women with or without NAFLD at Mount Sinai Hospital. We reviewed the electronic health record charts of 536 infants for neonatal, 6 month, and 1 year outcomes. If a mother removed her child from MSHS for pediatric care, we called those mothers and obtained consent to collect data over the phone. Primary outcomes were weight and weight percentile at birth, 6 months, and 1 year. Secondary outcomes included APGAR score, neonatal complications, and developmental milestone acquisition at 6 months and 1 year. We compared the outcomes in the infants of mothers with NAFLD to infants of mothers without NAFLD using a chi-square test or a twotailed independent samples T test.

RESULTS: We obtained neonatal data for 486 infants (73/486 NAFLD), 6 month data for 202 infants (32/202 NAFLD), and 1 year data for 155 infants (25/155 NAFLD). Maternal NAFLD was positively associated with pre-pregnancy BMI > 25 (p=0.001), increased maternal BMI at delivery (33.45 vs 31.92, p=0.0003), pregestational diabetes mellitus (p=0.0003), and gestational diabetes mellitus (p=0.024). Maternal NAFLD was not associated with significant difference in rate of preterm delivery, weight or weight-for-age percentile at birth, or weight or weight-for-length percentile at 6 months and 1 year. Maternal NAFLD was negatively associated with developmental delay (p=0.028), particularly physical developmental delays (p=0.024), at 6 months, however at 1 year there was no significant difference between the groups.

CONCLUSIONS: Although we identified metabolic differences between mothers with and without NAFLD, we did not identify a signal towards impact on pediatric growth in the first year of life. Further research is needed to confirm if these trends last throughout childhood, as well as to determine if any subcohort of women with NAFLD (i.e. certain BMIs or more advanced liver disease) may impact pediatric outcomes.

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ABSTRACT 49 MIDTERM FUNCTIONAL AND PATIENT-REPORTED OUTCOMES IN SHOULDER ARTHROPLASTY PATIENTS OVER THE AGE OF 75.

Benjamin Gross1, Jordan Bernstein2, Carl Cirino2, Christopher White1, Akshar Patel2, Bradford Parsons2, Evan Flatow2, Paul Cagle2. 1Medical Education, 2Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Shoulder arthroplasty is being performed in increasing numbers across all segments of the population, including the elderly.

OBJECTIVE: To examine midterm functional and patient-reported outcomes in elderly patients who underwent either anatomic or reverse total shoulder arthroplasty.

METHODS: Retrospective review was performed on patients who underwent anatomic total shoulder arthroplasty (aTSA) or reverse total shoulder arthroplasty (rTSA) between 2000 and 2018. Inclusion criteria was patient age ≥75 years at surgery and ≥2 years postoperative follow-up. Primary outcome measures were differences in Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) score, Visual Analog Scale (VAS) pain score, and ranges of motion. Secondary outcome measure was the need for revision procedures. Univariate analyses were performed with χ2 test for categorical variables, and student’s t-test for continuous variables.

RESULTS: 21 patients who underwent aTSA and 18 patients who underwent rTSA were included. Mean age at surgery was 79 and 80 in the aTSA and rTSA groups, respectively (p=0.4). Mean postoperative follow up was 6.5 years across both cohorts. aTSA patients experienced improvements in VAS (pre-op: 7 ± 3, post-op: 1 ± 1; p<0.001), ASES (pre-op: 25 ± 15, post-op: 75 ± 20; p<0.001) and SST (pre-op: 2 ± 1, post-op: 8 ± 3; p<0.001) scores. rTSA patients also experienced improvements in VAS (pre-op: 7 ± 2, post-op: 1 ± 2; p<0.001), ASES (pre-op: 30 ± 16, post-op: 74 ± 22; p<0.001), and SST (pre-op: 1 ± 0.7, post-op: 7 ± 4; p<0.001) scores. aTSA patients experienced improved external rotation (pre-op: 17 ± 15, post-op: 52 ± 9; p<0.001) forward elevation (pre-op: 108 ± 35, post-op: 155 ± 19; p<0.001), and internal rotation (pre-op: L5, post-op: T10; p<0.001). rTSA patients experienced improved forward elevation (pre-op: 62 ± 34, post-op: 133 ± 25; p<0.001), decreased external rotation (pre-op: 30 ± 29, post-op: 18 ± 21; p=0.09), and increased internal rotation (pre-op: L3 postop: L1; p=0.09). No aTSA patients required any revision surgeries while one rTSA patient did (p=0.3).

CONCLUSIONS: This study shows that aTSA and rTSA can be performed in the elderly population with acceptable midterm outcomes. Both techniques yield improvements in, and maintained outcomes for, patient satisfaction and shoulder functionality. These results can assist physicians and patients in the decision making process for undergoing shoulder arthroplasty.

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ABSTRACT 50 PANCREATIC NEURAL CIRCUITRY IN OBESITY AND DIABETES. Rollie Hampton1, Alexandra Alvarsson2, Maria Jimenez2, Rosemary Li2, Kavya Devarakonda2, Sarah Stanley2. 1Medical Education, 2Neuroscience. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Pancreatic islets are richly innervated. Use of 2D immunohistochemistry and extreme models of obesity and diabetes have limited our understanding of pancreatic nerve anatomy. Additionally, our knowledge of the direct roles of pancreatic nerves in regulating pancreatic function is incomplete. Determining how high-fat diet (HFD) impacts pancreatic nerve structure and function will provide novel insights into the mechanisms and pathophysiology of obesity and Type 2 Diabetes.

OBJECTIVES: Firstly, we aim to create a comprehensive atlas of pancreatic sympathetic and parasympathetic fibers throughout the pancreas and the time course of HFD-induced structural changes by combining tissue clearing with high-resolution 3D imaging. Secondly, we aim to determine the direct physiological roles of pancreatic efferent nerves on islet hormone secretion and the effects of HFD consumption on these roles.

METHODS: To test the hypothesis that HFD causes structural changes in pancreatic innervation, C57Bl6 mice were randomized to HFD or low-fat diet (LFD) groups. Metabolic phenotyping consisted of weekly body weight, plasma glucose measurements, and intraperitoneal glucose tolerance testing after 1, 4, and 12 weeks of feeding. Pancreata were cleared and immunolabeled according to iDISCO+ and imaged by lightsheet microscopy. Imaris software allows for image processing and unbiased quantification of neural and endocrine volumes. To test the roles of pancreatic parasympathetic nerves on islet hormone release and the effects of HFD, cre-dependent hM3D(Gq)-mCherry or mCherry viral constructs were injected into the pancreatic duct of ChAT-IRES-cre mice. ChAT-cre mice were fed LFD or HFD for 1 or 4 weeks and the effects of neuromodulation were assessed.

RESULTS: HFD significantly impairs glucose tolerance and insulin sensitivity and rapidly remodels islet sympathetic and parasympathetic innervation. Targeted activation of pancreatic parasympathetic efferent nerves improves glucose tolerance.

CONCLUSIONS: HFD remodels pancreatic innervation and these changes may contribute to insufficient insulin release to maintain normoglycemia. Targeted activation of pancreatic parasympathetic nerves improves glycemic control. Future studies will assess the physiological roles of pancreatic sympathetic efferent nerve function on islet hormone secretion and will also determine changes in pancreatic efferent nerve function with long-term HFD feeding.

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ABSTRACT 51 A QUALITATIVE STUDY OF PATIENT PERCEPTION AFTER COMPLETING A CLINICAL RESEARCH STUDY. Celestine He1, Bridget Mueller2, Gina Lee2, Gabriela Cedillo2, Alyha Benitez2, Shanna-kay Griffiths2, Jessica Robinson-Papp2, Mary Catherine George2.

1 Medical Education, 2Neurology. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Understanding why individuals participate in clinical research is important to ensure accurate representation and inclusion of diverse and under-represented identities [1-2]. Many studies, however, focused on oncology patients, may have limited generalizability to other diseases. Few studies have focused on patients with chronic medical conditions where the benefit to research participation is less clear OBJECTIVE: Identify factors that motivate diverse patients with chronic neurologic conditions to enroll in a Phase II clinical research study.

METHODS: Participants were recruited from a Phase II study investigating how vagal dysfunction affects gastrointestinal (GI) and immune function in patients living with HIV. Study participants all successfully completed a battery of testing that assessed autonomic function, gut motility, blood, stool and saliva.

Participants consented to a semi-structured, recorded interview and answered a demographic questionnaire.

Transcripts were analyzed for primary themes using grounded theory methodology [3].

RESULTS: Seven subjects were interviewed. Two identified as African American, two Hispanic/Latino, and three Caucasian. Four subjects identified as male, two as female, and one as nonbinary. Five had a chronic GI disorder and four were HIV positive. Three key themes influenced subject participation: personal health conditions, connection to a ‘health’ community, and empathetic interactions with the study team. Six participants expressed that learning more about their unknown chronic medical condition, whether it be the cause, pathogenesis, or simply ‘more,’ motivated their participation in the study. Four participants reported a desire to help their ‘health’ community (example, HIV). Along with these motivators, the positive and empathetic interactions with the study team eased any discomfort of the testing procedures and influenced participant retention.

CONCLUSION: This study revealed three keys theme that influence subject participation and can inform future Phase II study recruitment. Planned studies will examine generalizability to other laboratories and patient populations.

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ABSTRACT 52 DEVELOPMENT OF A MACHINE LEARNING MODEL TO IDENTIFY ELBOW IMPLANTS FROM RADIOGRAPHIC IMAGES. Philip Henson1, Nima Assad1, Brian Cho1, John Schwartz1, Eric Geng1, Varun Arvind1, Samuel Cho2, Jun Kim2. 1Medical Education, 2Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Total elbow arthroplasty (TEA) rates continue to rise year after year with up to 7.6% annual growth, yet complication and failure rates have been reported as high as 90%. Proper identification of an elbow implant is considered to be a critical component of preoperative planning prior to revision surgery in order to reduce rates of improper identification, save time in the clinical workflow, and enhance postoperative outcomes.

OBJECTIVES: To develop a machine learning algorithm to quickly and accurately identify elbow implants from radiographic images.

METHODS: 141 elbow implant radiographs representing 5 unique prostheses were obtained from deidentified patients within The Mount Sinai Health System in New York, NY. Labels were created from existing manual guides for elbow implant identification. Images were split into 70% training and 30% test sets. A modified version of the convolutional neural network (CNN) DenseNet-121 was used to train and evaluate the data. The model was then assessed for accuracy (percentage of correct predictions), sensitivity (the ratio of correctly classified images to the total number of images), positive predictive value (the number of images classified in a given label divided by the number of these images that truly belong in the label), and f-1 scores (the average of the precision and recall of the model).

RESULTS: Overall model accuracy was 97.8% and top-3 accuracy was 100% for each of the 5 prostheses.

Sensitivity, positive predictive value, and F1 scores for the model were 0.978, 0.980, and 0.96, respectively.

The algorithm took 14.10 seconds to classify all 141 images, averaging 0.1 seconds per image.

CONCLUSIONS: The model demonstrated strong performance in the identification of elbow implants among the sample of 141 images and 5 implant types. These results suggest clinical utility in future implementation of this elbow implant identification algorithm to improve preoperative planning for revision surgery within surgical workflows.

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ABSTRACT 53 RESILIENCE FACTORS AND COPING STRATEGIES AMONG MEDICAL STUDENTS DURING THE COVID-19 PANDEMIC: AN EXPLORATORY STUDY. Josimar Hernandez Antonio1 , Ezequiel Ramos1, Jordyn Feingold2, Vedika Kumar3, Emma Stanislawski4, Alicia Hurtado1, Ksenia Gorbenko5, Craig Katz1. 1Medical Education, 2,3,4 Psychiatry, 5Population Health Science and Policy. 1,2,5Icahn School of Medicine at Mount Sinai, New York, NY, 3Zucker Hillside Hospital, 4Maine Medical Center.

In its disruption of every major facet of life, the COVID-19 pandemic has greatly affected medical students.

A few studies have used surveys to understand the impact of the pandemic on medical education specifically.

Yet, very little is known about the subjective experiences of medical students living in New York City during the pandemic – once considered the epicenter of the pandemic in the United States. In this exploratory study, we interviewed medical students to gain an understanding of their resilience factors and coping strategies.

Qualitative, semi-structured, telephone interviews were conducted using a purposive sample of medical students at ISMMS across all school years. Students were asked open-ended questions over the phone about how the pandemic affected their personal life, work life, emotional state, relationships, etc. Interviews were recorded, transcribed, and coded using Dedoose software to identify salient themes. Themes were reviewed by all co-authors. A total of 40 interviews were conducted. Salient themes noted from interview transcripts reveal that many students relied on a variety of resilience factors and coping strategies, most notably: adaptability (e.g., “I think I've been pretty flexible and cognizant of all the changes going on. And I feel pretty comfortable changing the way I do things.”), altruism (e.g., “Volunteering has brought me joy.

And it's always brought me a sense of meaning, but that continues right now. And fortunately, I'm able to do it remotely”), gratitude (e.g., “I've been very privileged – I know that – I can afford to live somewhere and I have the means to stay where I was or if I wanted to leave I could, there were places I could go, so I I'm lucky in that respect”), and social support (e.g., “I felt like this was valuable time to be home with my family, and I don't know the next time that that will happen”). The coping strategies found most frequently among medical students can be understood collectively as engagement coping. These findings suggest that providing students with enough opportunity to reflect, volunteer, develop flexibility, and engage in supportive interpersonal relationships can be helpful in mitigating the stress created by the pandemic as well as the stress created by medical education in general; although further research would be needed to clarify the direct effect that these coping strategies have on stress.

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ABSTRACT 54 TOTAL JOINT ARTHROPLASTY COSTS ASSOCIATED WITH MEANINGFUL IMPROVEMENTS IN COMORBIDITY SUBGROUPS. Michael Herrera1, Sara Kiani2, Nicholas Pitaro2, Jashvant Poeran3, Brett Hayden3, Darwin Chen3, Calin Moucha3. 1Medical Education, 2Global Health. 3Orthopaedics. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Higher American Society of Anesthesiologists (ASA) Physical Status classification and comorbidity burden are generally associated with adverse outcomes and higher costs in total joint arthroplasty (TJA) patients. It is unclear to what extent post-TJA improvements in physical function, and costs required to achieve these improvements, differ between patient subgroups.

METHODS: This prospective cohort study included 402 TJA patients (2017-2020) with pre-TJA and 1-year post-TJA Veterans Rand 12 (VR-12), Hip Disability/Knee Injury and Osteoarthritis Outcome Score (HOOS/ KOOS) values. Absolute pre-/post HOOS/KOOS/VR-12 scores and proportions of those achieving minimal clinically important differences (MCID) were compared between ASA categories, and those with and without diabetes mellitus (DM) and coronary artery disease (CAD); Kruskal-Wallis and Fisher’s exact tests were applied, respectively. Using direct costs, we calculated the median cost required to achieve MCID in each of the comorbidity subgroups.

RESULTS: Across ASA I-IV categories the median HOOS/KOOS improvement was 39.8, 30.3, 32.9, and 51.6 points, respectively (p=0.359); this was 66.7%, 72.2%, 69.5% and 87.5%, respectively (p=0.713) for proportions of patients achieving MCID. Costs required to achieve MCID (median range: $10,273-$14,195) differed significantly between ASA categories (p=0.011). Among patients with and without DM the median HOOS/KOOS improvement and percent achieving MCID was 33.4 and 31.7, and 66.2% and 72.5%, respectively (both p>0.05). Among patients with and without CAD the median HOOS/KOOS improvement and percent achieving MCID was 33.3 and 31.3, and 77.3% and 70.7%, respectively (both p>0.05). Costs required to achieve MCID differed significantly between patients with and without DM ($13,597 versus $11,610) and CAD ($9,915 versus $12,256), both p<0.05.

CONCLUSIONS: Improvements in physical function are universal across patient comorbidity subgroups, even though they are sometimes associated with higher costs to achieve MCID. This data may inform discussions on TJA candidate selection, especially those traditionally seen as suboptimal candidates.

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ABSTRACT 55 EVALUATING THE IMPACT OF COMPREHENSIVE MALARIA EDUCATION ON THE USE OF LONG-LASTING INSECTICIDAL NETS IN JINJA, UGANDA. Skylar Hess1, Olivia Oberkircher1, Xueying Zhang2, Jessie Stone3, Nils Hennig4.

1 Medical Education. 4Pediatrics. 1,2,4Icahn School of Medicine at Mount Sinai, New York, NY, 3Soft Power Health, Kyabirwa, Uganda.

BACKGROUND: Malaria remains endemic in Uganda, influencing morbidity, mortality and socio-economics.

Soft Power Mukagwa Allan Stone Community Health (SMACH) has been distributing subsidized long lasting insecticidal nets (LLINs) along with education sessions in Jinja, Uganda for 10 years. However, few studies have investigated LLIN use following distribution in order to most effectively guide malaria reduction efforts.

OBJECTIVE: To evaluate the impact of education on proper LLIN usage and assess family-wide understanding of malaria. We hypothesize that an educational program administered during LLIN distribution may increase correct LLIN usage and knowledge regarding malaria transmission, symptoms, and treatment.

METHODS: Households receiving LLINs from SMACH were selected to participate in this study.

Standardized questionnaires were used to assess LLIN knowledge and self-reported use, as well as malaria understanding. We collected questionnaires from 966 households, representing approximately 5,000 individuals. Mixed effects logistic regression was performed.

RESULTS: The number of correctly hung nets was higher in families who attended SMACH education sessions versus those who did not (2.5 vs. 2.2, p=0.03). Between families with and without adults who attended education sessions, there was no difference in the number of participants who slept under LLINs every night (98.1% vs. 96.5%, p=0.15). Additionally, there was no difference in the number of participants who correctly identified mosquitos as the vector for malaria (94.5% vs. 94.5%, p=0.99). Only 52.3% of educated families and 49.5% of uneducated families identified that fever is a symptom of malaria, with no significant difference (p=0.5). Among families who attended education sessions, 56.6% shared what they learned with others. Lastly, the most common reasons for not hanging all nets included damage (45.7%) or reserving nets for emergencies (29.5%).

CONCLUSION: Families who attended SMACH education sessions had more nets hung correctly than families who did not receive education. This indicates that culturally sensitive education may help close the gap between LLIN possession and correct usage. While most families with LLINs are sleeping under them, the questionnaire highlighted a significant gap in awareness of malaria symptoms, which may lead to delays in seeking treatment. Understanding these inter- and intra-household factors can help direct and further refine malaria control efforts in Uganda.

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ABSTRACT 56 ADHD BASELINE IMPACT SCORES AND THE EFFECT OF STIMULANTS ON COMPOSITE SCORES. Eugene Hrabarchuk1, Theodore Hannah2, Adam Li2, Alexander Schupper2, Lily McCarthy2, Muhammad Ali2, Roshini Kalagara2, Alex Gometz3, Mark Lovell4, Tanvir Choudhri2. 1Medical Education, 2,4Neurosurgery, 3 Rehabilitation Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, NY, 3Physical Medicine and Rehabilitation, Concussion Management of New York, 4University of Pittsburgh Medical Center.

BACKGROUND: Athletes with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of concussion. The Immediate Post-Concussion Assessment & Cognitive Testing (ImPACT) test has been shown to be sensitive and specific in assessing for concussion presence, but baseline or pre-concussion scores can vary across populations. Stimulants are the mainstay for neurocognitive and impulsivity treatment in subjects with ADHD, however, the effects of ADHD and stimulant use on neurocognitive function in young adolescent athletes require further investigation.

OBJECTIVE: Since athletes diagnosed with ADHD are at increased risk for concussion, the objective was to determine how stimulant use affects baseline concussion composite scores in student-athletes diagnosed with ADHD. METHODS: A database of 11563 ImPACT assessments of 7454 student-athletes between the ages of 12 and 22 from 2009 to 2019 was queried for participants reporting an ADHD diagnosis. The first baseline test for each participant was included; subjects who did not answer yes or no to the question of prior ADHD diagnosis were excluded. After exclusions, there were 353 ADHD subjects and 7090 controls. Demographic differences were compared with Chi-squared analyses. Multiple linear regression analyses were used to compare the independent effect of ADHD and stimulant use on subjects while controlling for relevant confounding variables including symptom burden.

RESULTS: Univariate analyses indicated that ADHD diagnosis with and without stimulant is associated with worse symptom (β = 3.43, 95% CI: 2.34-4.52, p<.0001) and impulse control (β = 0.83, 95% CI: 0.30-1.37, p=.002) scores. This association on symptom (β = 2.64, 95% CI: 1.38-3.89, p<.0001) and impulse control (β = 0.72, 95% CI: 0.09-1.36, p=.03) scores were maintained in multivariate analysis. Within the ADHD cohort, multivariate analysis demonstrated stimulant-use was associated with increased visual motor baseline scores (β = 2.27, 95% CI: 0.54-4.01, p=0.01), but was not significantly associated with any other composite scores.

CONCLUSIONS: Participants with ADHD reported higher baseline symptoms and had worse impulse control composite scores. Stimulant use in participants with ADHD was associated with improved visual motor scores. The ADHD cohort that used stimulants did not demonstrate the expected reduction in elevated impulse control scores suggesting a need to further research stimulant medications in populations diagnosed with ADHD.

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ABSTRACT 57 CORRELATES OF PATIENT-REPORTED HEALTH MEASURES IN PATIENTS WITH MULTIVESSEL CORONARY ARTERY DISEASE UNDERGOING PERCUTANEOUS CORONARY ARTERY INTERVENTION. Suvruta Iruvanti1, Amit Blumfield2, Clayton Snyder3, Gurpreet Johal3, Samantha Sartori3, Birgit Vogel3, Gennaro Giustino3, Htoo Kyaw3, George Dangas3, Roxana Mehran3, Annapoorna Kini3, Samin Sharma3, Serdar Farhan3. 1Medical Education, 3Medicine. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. The abbreviated version of the Seattle Angina Questionnaire score (SAQ-7) is a validated tool to assess patient-reported health measures. SAQ-7 provides a patient-self reported measure of three subdomains: quality of life (QL), frequency of angina (FA), and physical limitation (PL). Lower scores indicate more symptoms related to coronary artery disease (CAD), but other comorbidities may also have an impact on SAQ-7 in these patients. Since 2015, SAQ-7 has been assessed in all patients presenting for elective coronary angiography at MSH. This work identifies the correlates of SAQ-7 changes after percutaneous coronary intervention in patients with multivessel coronary artery disease. SAQ-7 was obtained before each intervention. Correlates of baseline and deltaSAQ-7 were assessed using a univariate linear regression analysis. All variables for which P<0.2 were forced into a multivariate model. SAQ-7 was analyzed as a continuous variable but broken into tertiles for ease of generalizing clinically relevant findings to physician practice. Ease of generalizability was also why SAQ-7 values of 60 and 10 were chosen as cutoffs.

531 patients fulfilled the inclusion criteria for the present analysis. Mean patient age was 65.7 (SD=10.3) years.

21.7% (115/531) of patients were female. At baseline, the prevalence of the following differed significantly among patients with SAQ-7 in different tertiles: female sex; nonwhite race other than African American, Hispanic or Asian (NWR); diabetes mellitus (DM); prior coronary artery bypass graft (CABG); and neoplastic disease. The following are presented based on multivariate adjusted odds ratios. Female sex, chronic lung disease (CLD), Asian race, NWR and CABG were significantly associated with an increased likelihood of an index procedure summary-SAQ-7 <60. The variables associated with an increased likelihood for an index SAQ-7 subdomain score <60 were: female sex, DM and CABG for PL; female sex and CAGB for QL; and in-stent restenosis for FA. The following had a significant association with patients’ improvement in SAQ-7 by >10 points: increase in body mass index (BMI) and the presence of bifurcation lesions for summary-SAQ-7; and increase in BMI for PL and FA. CLD was significant for a decreased likelihood of a FA score increase >10 points.

Addressing comorbidities such as BMI, DM and CLD, as well as socioeconomic factors, can help improve CAD patients’ self-assessment of angina, physical limitation and well-being.

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ABSTRACT 58 CORONARY ARTERY CTA PRIOR TO CARDIOVASCULAR SURGERY: A RELIABLE, LESS INVASIVE ALTERNATIVE TO CATHETERIZATION FOR ROUTINE PREOPERATIVE SCREENING. Yonatan Israel1, Percy Boateng2, Ahmed El-Eshmawi2, David Adams2, Dimosthenis Pandis2.

1 Medical Education, 2Cardiovascular Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Invasive coronary angiography is the gold standard for routine screening of baseline coronary artery disease (CAD) prior to cardiovascular operations and is known to carry a small albeit welldescribed morbidity and mortality risk from direct structural injury and/or contrast-related renal insult.

OBJECTIVE: To determine whether routine use of the less invasive coronary Computed Tomographic Angiography (CTA) results in fewer procedure-related complications rates compared to invasive coronary catheterization.

METHODS: Using the national registry of the Society of Thoracic Surgery (STS) adult cardiovascular database, we retrospectively reviewed prospectively captured and reported cardiovascular operative data from consecutive patients which underwent direct-access mitral valve (MV) repair or replacement in our institution, from 2011 to 2021. Operative and 30-day major adverse events were compared between the two study groups. Local Institutional Review Board approval of the study protocol included a waiver of patient consent.

PRELIMINARY RESULTS: 1712 consecutive operative cases met study criteria (1318 CATH, 394 CTA) and were included in the study (47.5% females). Major adverse events were observed in 7.1% of the CATH subgroup and 3.8% of the CTA subgroup (OR: 1.94, 95% CI: 1.11 - 3.39, chi square: 5.62, p = 0.018). More specifically, new postoperative dialysis was observed at 2.05% in CATH, 0.254% in CTA (OR: 8.22, 95% CI: 1.11 - 60.7, chi square: 6.07, p = 0.014). Rates of readmission (p = 0.371) as well as perioperative RBC blood use (p = 0.134) were not statistically different. Infrequent outcomes such as reintubation, reoperative cardiac surgery, and postoperative sepsis demonstrated increasing trends in the CATH group, however, a larger sample size is needed to evaluate statistical significance.

CONCLUSION: The less invasive coronary CTA procedure was observed to have decreased frequency of adverse events following MV procedures. Future direction will include a larger patient population sample to evaluate statistical significance in rare outcomes, as well as compare complications due to unforeseen coronary anatomy such as unplanned CABG between the subgroups.

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ABSTRACT 59 AUTOMATED DETERMINATION OF LEFT VENTRICULAR FUNCTION USING ELECTROCARDIOGRAM DATA IN PATIENTS ON MAINTENANCE HEMODIALYSIS. Joy Jiang1 , Akhil Vaid2, Ashwin Sawant3, Patricia Kovatch2, Alexander Charney2, Benjamin Glicksberg2, Lili Chan3, Girish Nadkarni3. 1Medical Education, 2Genetics and Genomic Sciences, 3Medicine.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Left ventricular systolic dysfunction is common in persons on maintenance hemodialysis (HD) and is associated with increased risk of mortality. Early identification of patients with depressed left ventricular ejection fraction (LVEF) may lead to better risk stratification and facilitate earlier initiation of therapeutic and preventive measures. Electrocardiograms (ECGs) are routinely performed in patients on HD, and we aim to use such data for prediction of LVEF in this population.

METHODS: We identified patients on HD between 2011 and 2020 at five hospitals in the Mount Sinai Health System: Mount Sinai Hospital, Mount Sinai Morningside, Mount Sinai West, Mount Sinai Brooklyn, and Mount Sinai Beth Israel. The majority of patients were non-White or of unknown race. All patients on HD had a transthoracic echocardiogram within 7 days of an ECG, indicated by diagnostic and procedure codes. We developed four models: 1) trained from scratch in only HD patients, 2) pre-trained on a publicly available set of natural images (ImageNet), 3) pre-trained on all non-HD patients (n=705,075 ECG: Echo pairs for 158,840 patients) and 4) pre-trained on non-HD and fine-tuned on HD patients (n=18,626 ECG: Echo pairs for 2,168 patients) using Transfer Learning (TL). Model performance was compared by Area Under Receiver Operating Characteristic curve (AUROC) for clinically relevant LVEF categories.

RESULTS: We divided patient LVEF values into three clinically relevant classifications of ≤40% (461 patients, or 21.2% of cohort), 41 to ≤50% (398 patients, 18.4%), and >50% (1,309 patients, 60.4%). The TL model consistently outperformed other models in this study with AUROCs of 0.86, 0.63, and 0.83 in LVEF categories of ≤40%, 41 to ≤50%, and >50% respectively. We also found that in-hospital mortality in patients on HD with predicted LVEF of ≤40% had a survival probability of 70%. TL model predictions were associated with mortality in a Cox regression with an adjusted hazard ratio of 1.46 (95% CI: 1.10-1.93; p=0.01). To validate the performance of the TL model using the Youden Index, in-hospital mortality over a 5-year follow-up period was higher in the true positive and false positive groups compared to true negatives.

CONCLUSION: This study shows the utility of deep learning for automated determination of cardiac function from ECG and the potential of TL for risk prediction in smaller patient populations.

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ABSTRACT 60 LONGITUDINAL CHANGES IN ATTENTION AND MEMORY IN PREGNANT AND POSTPARTUM WOMEN. Matina Kakalis1, Emma Smith2, Vignesh Rajasekaran2, Katherine Samonek3, Lindsay Jamieson3, Kellyn Kuczarski3, Lotje de Witte2, Daniel Katz4, Kelly McMeen2, Harold Koenigsberg2, Erin Hazlett2, Antonia New2, Robert Pietrzak5, Margaret McClure6, M. Mercedes Perez-Rodriguez2. 1Medical Education, 2,5,6 Psychiatry, 4Obstetrics, Gynecology, and Reproductive Science. 1,2,4Icahn School of Medicine at Mount Sinai, New York, NY, 3,6Fairfield University, Fairfield, CT, 5Yale University, New Haven, CT. BACKGROUND: Pregnant/postpartum women experience significant physiological changes, yet detailed cognition studies in this population are scarce as they are often excluded from large cohorts. Moreover, to date, these studies have used separate pregnant and non-pregnant control cohorts. Despite correcting for variables, comparisons of these heterogeneous independent groups remain subject to additional confounders. Additionally, many studies utilize self-report measures which correlate poorly with objective assessments of cognition.

Cognitive changes in vulnerable pregnant/postpartum cohorts warrant further assessment. This study investigates these changes using the Cambridge Neuropsychological Test Automated Battery (CANTAB), a validated remote cognitive assessment and compares pregnant/postpartum cognition in the same cohort, using within group comparison design.

OBJECTIVE: To assess pregnant/postpartum cognition with a focus on attention and memory.

We hypothesize that cognition in pregnancy will be impaired and then return to baseline 3 months postpartum.

METHODS: Participants were recruited from the Generation C cohort (N>3000), a prospective pregnancy cohort in the Mount Sinai Health System. Participants completed assessment at approximately 36 weeks pregnant (n=38) or four months postpartum (n=22). A subset of participants (n=14) completed both prenatal and postnatal cognitive assessments (mean age=36, SD=2.43). Assessments consisted of domains of memory measured by Paired Associates Learning (PAL) (n=10); Spatial Working Memory (SWM) (n=8); Delayed Matching to Sample (DMS) (n=14); Pattern Recognition Memory (PRM) (n=7) and attention measured

by Rapid Visual Information Processing (RVP) (n=8). Normative scores for populations of adults 18-65 were used to examine cognitive performance in prenatal and postpartum periods.

RESULTS: There were significant differences in prenatal and postnatal RVP A’ (mean difference= -0.569, p=0.007) and SWM (mean difference= -0.813, p=0.032) scores across the entire cohort. In a subset of participants who completed prenatal and postnatal assessment there were significant differences on a paired sample t-test in PAL (p=0.004), SWM (p=0.022), and RVP A’ (p=0.006) scores.

CONCLUSIONS: These significant differences suggest improvements in attention and memory from pregnancy to postpartum. These findings will be validated in a larger sample (target n=500) as this project is ongoing.

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ABSTRACT 61 PORTABLE STROKE DETECTION IN A COMPREHENSIVE STROKE CENTER: PILOT DEPLOYMENT OF THE CEREBROTECH VISOR. Roshini Kalagara1, Susmita Chennareddy2, Colton Smith2, Stavros Matsoukas2, Abhiraj Bhimani2, Christopher Kellner2. 1Medical Education, 2Neurosurgery. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Stroke is a leading cause of morbidity and mortality, with worse outcomes associated with increasing time-to-treatment. As stroke subtypes are currently not confirmed until in-hospital imaging is obtained, portable stroke detection technology can play a role in reducing time to stroke diagnosis and treatment. The Cerebrotech Visor is an FDA-approved portable bioimpedance detection device that has been shown to differentiate severe stroke from minor stroke.

OBJECTIVES: To evaluate the accuracy of the Visor device in the detection of severe stroke in patients presenting as acute stroke codes.

METHODS: All patients presenting to the emergency department and receiving a stroke code at two hospitals from November 2020 to July 2021 were eligible for inclusion. Trained operators completed device scans on eligible patients whenever a trained operator was available. The device functioned by detecting asymmetry in bioimpedance across a wide range of electromagnetic wavelengths to provide an algorithmically derived Visor score. Visor scores, time to scan, and in-hospital imaging findings were recorded prospectively in a quality assurance database. X statistical tests were performed.

RESULTS: During the time period, 87 patient scans were attempted. Patients without successful scans, due to reasons like patient motion and low patient tolerance of the device, were excluded. Patients with underlying diseases noted in scan comments that would alter the baseline brain landscape, such as advanced dementia, were also excluded. In total, 78 patients were included in this analysis, with a mean age of 69.2 years (σ = 14.3).

Scans were most frequently performed in the emergency department and took an average of 105 seconds.

Using patient CT data, patients were divided into two groups based on normal or abnormal CT findings.

Patients with abnormal CT findings have significantly higher Visor scores (8.56 vs 7.11, p = 0.0495).

CONCLUSION: The Cerebrotech Visor is a portable stroke detection device that has the ability to detect alterations in brain bioimpedance in under two minutes. Though a large scale validation study must be performed to assess the accuracy of the device to diagnosis specific neurologic conditions, this pilot series of patients undergoing assessment as acute stroke codes demonstrates that this device may provide a rapid method for the in-hospital triage of severe stroke, reducing time-to-treatment for these patients.

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ABSTRACT 62 LIVING WITH HEPATITIS C AFTER INCARCERATION: A QUALITATIVE STUDY OF FORMER OFFENDERS' EXPERIENCES. Samir Kamat1, Shumayl Syed1, Sankeerth Kondapalli2, Ksenia Gorbenko3, Joel Cantor4, Aakash Shah5, Matthew Akiyama6. 1,2Medical Education, 3Population Health Science and Policy.

5 Emergency Medicine, 6Medicine. 1,3Icahn School of Medicine at Mount Sinai, New York, NY, 2Rutgers New Jersey Medical School, Newark, NJ, 4Rutgers University, 5Hackensack Meridian School of Medicine, 6 Albert Einstein College of Medicine, NY. BACKGROUND: Hepatitis C Virus (HCV) affects up to 35% of incarcerated individuals, with a majority returning to the community without having received treatment in jail or prison. Presently, there is a gap in knowledge about how these individuals fare after release. A better understanding about their experiences is important, as HCV’s chronic nature and long-term sequalae – fibrosis and hepatocellular carcinoma – underscore the need for expeditious treatment.

OBJECTIVE: To understand the lived experiences of formerly incarcerated individuals with HCV. METHODS: We conducted a qualitative analysis using semi-structured interviews with 20 people living with HCV who were recently released from incarceration at a statewide reentry program in a Northeastern state.

RESULTS: The thematic analysis revealed that responses largely pertained to one of four areas. First, that former offenders with HCV often feel dehumanized and inadequately educated on HCV during incarceration, which facilitate post-release HCV+ risk behaviors. Second, there are facilitators and barriers - such as overcoming housing and food insecurity, outstanding legal issues, domestic concerns --to reorienting to life outside the criminal justice system. Third, after release, they have difficulty navigating the healthcare system in terms of accessing providers. Fourth, that having the disease affects their sense of identity and how they interact more cautiously or remain mistrustful of family, friends, and providers.

CONCLUSION: The study identifies structural and individual level themes that shape the post-release experiences of HCV+ former offenders. Collectively, these insights suggest ways in which reentry service providers and policymakers may improve the screening and treatment of justice-involved individuals with HCV. Addressing competing priories associated with reentry and establishing HCV-specific programming can facilitate HCV self-management or appropriate linkage with providers.

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ABSTRACT 63 THE PSYCHOLOGICAL CONSEQUENCES OF THE COVID-19 PANDEMIC ON GRADUATE MEDICAL TRAINEES: A LONGITUDINAL ANALYSIS OF FACTORS CONTRIBUTING TO PROLONGED BURNOUT. Carly Kaplan1, Jonathan Ripp1, Saadia Akhtar2. 1Medical Education, 2Emergency Medicine.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Residents and fellows faced unique challenges during the COVID-19 pandemic, including redeployment, financial concerns and questioning their competence to care for COVID patients. During the pandemic peak, approximately 45% of trainees at the MSH screened positive for psychiatric symptoms or burnout. While our previous study examined the trainee experience during the crisis peak, few studies have investigated longitudinal impact or found key interventions to prevent sustained burnout.

OBJECTIVE: This study aims to assess the longitudinal burnout trajectory of the medical trainees working at the MSH during the peak of the COVID-19 crisis and the wave 1 factors associated with sustained burnout.

METHODS: Two anonymous surveys were electronically administered to residents and fellows working on the frontlines of COVID care during the pandemic at MSH. The first was sent during the apex of the crisis in Apr-May 2020; the second was sent between Nov 2020-Jan 2021. The two surveys were linked with anonymous identifiers to track individual trajectories between time points. Both surveys contained validated instruments to measure symptoms of Burnout (Mini-Z), Resilience (CD-RISC) and questions regarding demographics, coping, interventions, and COVID exposure.

PRELIMINARY RESULTS: Of the 560 trainee participants in the wave 1 survey, 184 (32.8%) responded to the wave 2 follow up and represented similar demographic characteristics. At wave 1, 47.8% of the sample were redeployed, 20.7% had increased hours, 57.1% had high team camaraderie, 90.7% felt valued by supervisors, and 32.6% were burned out. At wave 2, 39.3% were burned out. In bivariate analysis, factors that were significantly associated with burnout at wave 2 included female gender (47.3%vs.31.1%; p=.025), having <3 years in practice (46.7%vs31.3%; p=.046), having a previous mental health history (50.9%vs34.1%; p=0.032), having been redeployed during wave 1 (47.4%vs30.7%; p=.021), having duty-related worries (p=0.04) and having burnout at wave 1 (72.9%vs23.4%; p<.001). Factors associated with decreased wave 2 burnout were having felt valued by supervisors, and using positive emotion-focused coping at the apex. In multivariable analysis, using self-blame/venting to cope (OR:3.05, p=.025) and being in internal medicine specialty (OR:4.49, p=.008) were independently associated with increased wave 2 burnout, whereas higher resilience score was associated with decreased risk of burnout (p=.034).

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ABSTRACT 64 TCR SEQUENCING REVEALS HETEROGENOUS EFFECTS OF T CELL DEPLETION ON DONOR-REACTIVE T CELLS IN KIDNEY TRANSPLANT RECIPIENTS. Calla Khilnani1, Pamela Cruz-Encarnación2, Mehek Ningoo2, Miguel Fribourg-Casajuana3, Paolo Cravedi3, Peter Heeger3. 1Medical Education, 3Medicine. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: The pre-transplant detection of donor-reactive memory T cells in recipient blood correlates with an increased risk of future graft rejection. These memory cells are thought to be resistant to T celldepleting induction therapies, but the dynamics of donor-reactive memory immunity post-transplantation are incompletely understood. As the nucleotide sequence of each α/β T cell receptor (TCR) CDR3 region is unique, we used TCRβ sequencing (TCRseq) to assess donor-reactive T cell dynamics.

OBJECTIVE: To use TCRseq to test the hypothesis that donor-reactive memory T cells are resistant to T cell depletion.

METHODS: We analyzed stored aliquots of peripheral blood mononuclear cells (PBMCs) from 2 kidney recipients treated with T cell-depleting induction therapy (rabbit anti-human thymocyte globulin, rATG) plus standard maintenance immunosuppression. We stained recipient PBMCs with a surface dye that dilutes upon cell proliferation, stimulated recipient cells with donor cells, flow sorted the proliferating, donor-reactive T cells, and sequenced the TCR CDR3 β chain regions from extracted genomic DNA. We then sequenced all recipient PBMC TCRs from pre- and post-transplantation and used bioinformatics to quantify the frequencies of the identified donor-reactive clonotypes.

RESULTS: In patient 1, 4683 out of 186208 (2.5%) unique TCRs were donor-reactive pre-transplantation.

While the majority (89%) were detected at ≤ 5 copies pre-transplantation, 9 donor-reactive clonotypes were hyperexpanded (> 750 copies), consistent with donor-reactive T cell memory. Analysis of post-transplant samples (at 3, 6, and 9 months) showed that 8 out of 9 decreased in proportion by at least 63.5% after 9 months following rATG therapy, while 1 clonotype notably expanded by 39.5%. Similarly, in patient 2, we identified 5744 out of 46499 (12.4%) donor-reactive clonotypes, including 5 that were hyperexpanded. At 3 months post-transplantation, 2 out of 5 clonotypes decreased in proportion by at least 92.0%, but 3 expanded by 16.5%, 19.5%, and 193.9% despite rATG induction.

CONCLUSIONS: These preliminary findings suggest that a subset of pre-transplant, hyperexpanded, donor-reactive T cell clones are resistant to T cell depletion, potentially explaining the increased risk of rejection associated with preformed T cell memory. Ongoing analysis of additional patients, including those without rATG induction, will provide further mechanistic insight.

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ABSTRACT 65 FINANCIAL WORRY AND FOOD INSECURITY AT A PEDIATRIC CLINIC IN EAST HARLEM, NEW YORK CITY. Sonia Khurana1, Paige Cloonan1, Lauren Zajac2, Jennifer Acevedo3, Jenna Wisch2, Chris Gennings4, Shachi Mistry4, Arthi Vickneswaramoorthy2, Eve Spear2, Eden Alin2, Stephanie Wu2, Leora Mogilner2.

1 Medical Education, 2Pediatrics, 3Pediatric Environmental Health 4Population Health Science and Policy.

1,2,3,4 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Food insecurity (FI), which greatly impacts child health, has risen during the COVID-19 pandemic. To address FI in our outpatient pediatric practice, we connected our social determinants of health (SDH) screening program to an onsite food pantry and linked families with community-based organizations (CBOs) that address FI and related financial and social needs. However, caregiver financial worry in FI families is not well-studied.

OBJECTIVE: To characterize financial worry and FI in families screened by our SDH program.

METHODS: We screened families for SDH by phone or in-person prior to visits to a NYC pediatric clinic.

Those with FI (Hunger Vital Signs) were offered prospective study enrollment, and a food package and referral to a CBO pantry. Caregivers completed a self-administered survey including the USDA Household Food Security Survey to assess food security. Financial worry was measured with the Financial Domain of the Worry Domain Questionnaire (WDQ). Descriptive statistics, ANOVA, and linear regressions were done to assess the relationship between FI and financial worry.

RESULTS: From June-December 2021, we enrolled 48 caregivers. The most commonly identified race of the child was Black/African American (40%); 67% identified as Latinx ethnicity. 85% of children were publicly insured, and 58% of caregivers reported unemployment. Most families had marginal (25%) or low (52%) food security (signifying high FI). Caregivers were “quite a bit” or “extremely” worried about money running out (48%), not being able to pay bills (48%), limits to holidays/travel (44%), not being able to afford things (42%), and inadequate living conditions (33%). The median WDQ financial score was 3 out of 5 [2.2, 3.9], indicating a “moderate” mean worry score. On unadjusted ANOVA, higher worry was associated with increased FI (p=0.001). When adjusted for covariates, a likelihood ratio with a positive estimate showed that as FI increased, financial worry also increased (p=0.0002). Caregivers who did not complete grade 12/GED had lower financial worry (p=0.006) compared with those with graduate education (control).

CONCLUSIONS: Increased financial worry was associated with greater FI, and a higher caregiver education did not confer a protective factor over this relationship. Referral to CBOs addressing both FI and financial worry (e.g. entitlement programs) may benefit FI families. Impact of the SDH program on FI and financial worry will be evaluated over one year.

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ABSTRACT 66 THE UNTOLD STORY OF SCHLOENDORFF. Zainab Kiyam1, Jacob Appel2. 1Medical Education, 2Psychiatry. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. As one of the first legal cases to lay the earliest articulations of what is now known as informed consent, Schloendorff v Society of New York (1914) was brought to address a claim of medical malpractice in which a surgeon was accused of operating on an unwilling patient. Although much attention has been given to the 1914 opinion written on the case by Judge Benjamin Cardozo, little has been explored about the life of Mary Schloendorff and the litigation itself. Through a review of historical records and understanding the political, social history and factors that contributed to the case, we explore the clinical ethical errors that arose in the care of Mary Schloendorff including those of miscommunication among the patient and her care team, delegation of obtaining consent, and the extent of clinician autonomy within implicit consent. Although many legal analyses argue that the legal focus of the case was not directly on consent but on the immunity from liability of a hospital as a charitable organization from the actions of its physicians and staff, Mary Schloendorff’s care and case offer perspective on the impact of proper informed consent and the care team’s role in patient safety and quality improvement.

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ABSTRACT 67 EARLY POUCHITIS IS ASSOCIATED WITH LATER CROHN'S DISEASE-LIKE POUCH INFLAMMATION. David Kohler1, Michael Plietz2, Sergey Khaitov2, Patricia Sylla2, Alexander Greenstein2, Marla Dubinsky3, Maia Kayal3. 1Medical Education, 2Surgery, 3Medicine. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Restorative proctocolectomy (RPC) with ileal pouch anal anastomosis (IPAA) is the most commonly used surgical option for patients with ulcerative colitis (UC), as it restores continence and removes the need for an ileostomy. However, 10-20% of UC patients who have undergone IPAA develop Crohn’s Disease-Like Pouch Inflammation (CDLPI).

RESEARCH QUESTION: Is early onset of pouchitis (defined as development of pouchitis within the first year after IPAA) associated with development of CDLPI? METHODS: This was a retrospective cohort analysis of UC and IBD unclassified (IBDU) patients who underwent RPC with IPAA at Mount Sinai Hospital between January 2008 and December 2017. The primary outcome measured was the development of CDLPI. Predictors of CDLPI were assessed in univariable and multivariable cox regression models.

RESULTS: Our final patient cohort consisted of 412 patients who underwent at least one pouchoscopy between 2009 and 2018, of which CDLPI developed in 13.8% (n=57) after a median of 2.1 [IQR 1.1-4.3] years after final stage of IPAA surgery. On univariable analysis, early pouchitis (HR 2.43, 95% CI 1.32-4.45) and increasing number of pouchitis episodes (HR 1.38, 95% CI 1.17-1.63) were associated with an increased risk of CDLPI, while older age at time of colectomy (HR 0.97, 95% CI 0.95-0.99) was associated with decreased risk.

On multivariable analysis, early pouchitis (HR 2.35, 95% CI 1.27-4.34) was again associated with increased risk. Time to development of CDLPI was significantly less in patients with early pouchitis compared with those without (p=0.003).

SIGNIFICANCE: Our findings that early development of pouchitis is associated with CDLPI have the potential to significantly affect the care of patients who have undergone IPAA. Patients who develop early pouchitis should be monitored closely clinically, endoscopically, and through routine lab studies.

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ABSTRACT 68 MAKING THE CASE FOR PARKS AS A CRITICAL PART OF PUBLIC HEALTH PREPAREDNESS IN THE AGE OF COVID-19.

Niathi Kona1, Kathleen McGovern2, Andrea Deierlein3, Susan Teitelbaum2, Mary Wolff2, Maida Galvez2. 1Medical Education, 2Environmental Medicine & Public Health.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY, 3NYU School of Global Public Health, New York, NY. BACKGROUND: COVID-19 school closures and restrictions on indoor exercise facilities have decreased children’s opportunities for physical activity (PA), potentially increasing their risk for obesity. The pandemic has subsequently shone a light on the public health importance of parks for outdoor play for children and the need for public investment in parks. Yet, little is known about the physical characteristics of neighborhood parks and playgrounds that attract children to use outdoor spaces. The community-based longitudinal research project Growing Up Healthy in East Harlem examined associations between neighborhood park availability and children’s PA. RESEARCH QUESTION: What physical characteristics of East Harlem parks are associated with use by African American and Latinx children ages 6-8 years old?

METHODS: Characteristics of East Harlem open space resources were assessed via a comprehensive field study conducted by New Yorkers for Parks. Caregivers were asked about children’s neighborhood resource availability, use and weekly PA. Descriptive statistics were used to determine which open space characteristics were associated with use. Negative binomial models predicting count of children reporting use were built to determine which open space characteristics were most predictive of use.

RESULTS: Size of open space resource and number and diversity of active features (play areas, athletic fields, courts, recreation centers) were positively associated with child use (p < 0.05). Addition of one active acre increased the number of children using the resource by a factor of 4.4 (95% CI: 2.1-9.0); increasing the types of features from zero to two increased the number of children using the resource by a factor of 3.4 (95% CI: 1.1-10.7). More frequent use of open space resources (≥4x per week) was associated with a median of 0.97 metabolic equivalent (MET) hours of scheduled PA per week, compared to 0 MET hours with less frequent use (p < 0.05).

CONCLUSIONS: In the age of COVID-19, parks have emerged as a critical yet limited resource for physical activity, socially distant interaction, and mental wellness. Investment in large parks with abundant active features may play a crucial health promotion role for children.

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ABSTRACT 69 LEVERAGING AN INFORMATION EXTRACTION PIPELINE IN THE ANALYSIS OF VIRTUAL E-CONSULTS. Anish Kumar,1 Ann-Gel Palermo11Medical Education. 1Icahn School of Medicine at Mount Sinai, New York, NY. RubiconMD is a NYC-based health-tech start-up that offers e-consult services to primary care clinics and providers. Through RubiconMD’s platform, subscribed providers submit virtual consults to specialist physicians and receive timely guidance and expert feedback about managing their patients’ care. My project centered around applying natural language processing and related machine learning techniques to the wealth of textual data from the company’s e-consults, to better understand the clinical impact of their product for their clients.

The overarching goal was to extract detailed clinical information from the primary care providers’ consults and the specialist physicians’ responses. The approach was to do a preliminary analysis on their corpus of e-consults to get an idea of the data landscape. Next, we applied an information extraction pipeline to the data, using open-source software to do clinical entity extraction, entity disambiguation, and finally ontology linking to associate clinical concepts with standardized entries in the ICD10 and RxNorm classification systems. With standardized, extracted clinical entities tagged to each consult, it was then possible to apply a range of analysis techniques over a discrete set of e-consults or a time period. This included aggregating clinical conditions or other entities into impact reports for clients, to provide detailed insights into the specific questions upon which primary providers were consulting upon specialists.

We used unsupervised clustering method on entity-based representations of consults to analyze ambiguity in RubiconMD’s subspecialty categorization scheme. This analysis revealed that the “lesions” sub-specialty within the “Dermatology” specialty actually had further clinical subgroups including “neoplasms” and “inflammatory skin conditions.” Applying this technique to the Covid-19 specialty, I found that in the Spring of 2020, primary provider consults shifted from questions about management of acute Covid symptoms to those about management of complex cases and patients with comorbidities, specifically allergies, autoimmune/inflammatory conditions, and immunosuppressed conditions.

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ABSTRACT 70 IMPACT OF IMMUNOMODULATORY TREATMENTS ON SARS-COV-2 ANTIBODY RESPONSES IN ATOPIC DERMATITIS PATIENTS. Leore Lavin1, Benjamin Ungar2, Ana Pavel2, Emma Guttman2. 1Medical Education, 2 Dermatology. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Immunomodulatory therapies are used to treat moderate-to-severe atopic dermatitis (AD).

Whether dupilumab and systemic immunosuppressants affect COVID-19 antibody levels is unknown.

RESEARCH QUESTION: What are IgG antibody levels in patients taking immunomodulatory therapies for AD after COVID-19 infection and after mRNA vaccination?

METHODS: 54 pre-vaccination and 180 post-mRNA vaccination serum samples were collected prospectively in the Mount Sinai Department of Dermatology. Antibody levels were categorized into 4 groups: negative, weak, moderate, and strong. COVID-19 symptom severity was scored 0-2 (asymptomatic-moderate) based on patient report. 3 treatment groups were compared: 1) Limited: none or topical; 2) Systemics (JAK inhibitors, prednisone, phototherapy) and 3) Dupilumab.

Antibody group proportions were compared using two-sided Fisher test and log10 antibody level comparisons were performed using multivariate linear regression models. Spearman correlation captured post-vaccine antibody decline over time.

RESULTS: Among all 54 COVID-19-positive pre-vaccination samples, decreased symptom severity was associated with lower IgG antibody levels, consistent with prior studies. Asymptomatic and mildly symptomatic patients had lower antibody titers than those with moderate symptoms (p=0.03). Dupilumabtreated patients had significantly lower antibody levels than patients on Systemics when comparing both the proportions of weak vs. moderate/strong groups (p=0.01) and age-adjusted quantitative antibody levels (p=0.01). A similar lower trend was observed in Dupilumab vs. Limited groups (p=0.09). To assess if lower antibody levels were due to treatment-based modulation of antibody production or from differential responses to the virus itself, we assessed post-mRNA vaccination antibody levels. No IgG level differences were observed between treatment groups. A linear regression model adjusted for age and time since vaccination detected no significant differences in IgG concentrations between any treatment groups (p>0.18).

CONCLUSION: Patients had significantly lower antibody levels after COVID-19 infection when treated with dupilumab vs. systemic therapies, and lower levels compared with patients receiving limited therapy. However, there were no differences in antibody levels between treatment groups after mRNA vaccination. Our data suggest that dupilumab does not impair antibody responses but reduces COVID-19 symptom severity and resultant IgG levels.

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ABSTRACT 71 APPROACHES TO DEFINING THE MECHANISMS OF PERIANAL FISTULA INCEPTION IN AFRICAN AND EUROPEAN ANCESTRY CROHN’S DISEASE PATIENTS. Rachel Levantovsky1, Christopher Tastad2, Shikha Nayar2, Nai-Yun Hsu2, Ling-Shiang (Felix) Chuang3, Judy Cho3. 1Medical Education, 2Medicine, 3Genetics and Genomic Sciences. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Perianal fistulae are a high morbidity Crohn’s disease (CD) complication. African ancestry (AA) patients with CD have higher rates of perianal fistula than patients with European ancestry (EA). This observation is not currently explained by known genetic variants or differences in medical treatment. The predominant hypothesis underlying fistula tract progression is epithelial-mesenchymal transition (EMT).

However, the drivers of fistula inception at the rectal epithelium are unknown. Several genetic risk variants with high effect size in GWAS cohorts with AA patients are in monocyte associated genes, implicating monocyte recruitment to the intestine as a driver of CD. HYPOTHESIS: Rare variants or epigenetic mechanisms are present in patients with African ancestry that contribute to aberrant cellular interactions between the rectal epithelium and fibroblasts, resulting in impaired wound healing and fistula inception.

METHODS: To understand mechanisms of epithelial injury that contribute to perianal fistula in CD, we have employed direct ex vivo single cell -omic studies together with in vivo models of epithelial and monocyte differentiation to fibroblasts.

RESULTS: We have performed 3’ single cell RNA seq. on samples from n = 6 AA and n = 4 EA CD patients with perianal fistula history. These total n = 112,057 cells represent stromal, immune, and epithelial cell populations. We have also performed single nucleus ATAC + RNA seq. on n = 4 of these patients to measure chromatin accessibility, in conjunction with genotyping. These genetic, epigenetic, and transcriptomic data will be analyzed together with projection onto available bulk RNA seq. data. In vivo, I have cultured epithelial monolayers long-term from patient-derived rectal organoids that display sophisticated cellular architecture on histology, and express markers of cellular differentiation and maturity both at the RNA and protein level. Twoweek culture of CD14+ monocytes isolated from peripheral blood skews cells toward a spindle phenotype with expression of fibroblast markers. Preliminary data suggest that cells from AA healthy donors and patients are more prone to this spindle phenotype.

CONCLUSIONS: Using in vitro samples from the same patients from whom we obtain single cell data to validate our findings will provide unprecedented granularity into cell populations important in fistula inception and illuminate any differences between ancestry groups.

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ABSTRACT 72 PATIENTS AWARENESS OF FACTS AND MYTHS ASSOCIATED WITH DIETARY INTAKE AND KIDNEY STONES. Micah Levy1, Chih Peng Chin2, Evan Garden2, Krishna Ravivarapu2, Osama Al-Alao2, Joseph Sewell Araya2, Caner Dinlenc2, Michael Palese2. 1Medical Education, 2Urology. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Though peer-reviewed associations between dietary intake and kidney stones exist, it is difficult to gauge the extent to which patients know about such associations. Additionally, myths can misinform entire populations leading to misguided dietary choices. We identified factors influencing patients’ awareness of facts or myths related to diet and nephrolithiasis and determined whether awareness leads to action to prevent nephrolithiasis.

METHODS: Patients at a New York City urology clinic were administered surveys which collected demographic and prior kidney stone history. Patients reported their awareness of five facts and four myths about diet and kidney stones as well as the resources which influenced their awareness, and if they ever acted on this information, altering their diet to prevent kidney stones. Multivariable analysis identified factors that affect one’s awareness and determined how the resource of information affects action taken.

RESULTS: 202 surveys were analyzed. The average age of participants was 61 years old. 72% were male, 28% female. 26% reported completing high school/GED or lower, 43% had a college degree, and 31% had a graduate school degree. 45% reported at least one prior kidney stone. History of stones was associated with greater awareness of 4/5 facts and 1/4 myths. As number of stone events increased, so did patients' awareness of those facts and myths. As patient age decreased there was a greater awareness in 2/5 facts and 1/4 myths. As education level and concern for future stones increased there was greater awareness for 1/4 myths. Gender was not associated with greater awareness. Medical professionals were cited as the primary source of information for 3/5 facts, while personal research or the internet were cited for 3/4 myths.

For 4/5 facts and 1/4 myths, having a medical professional cited as the resource resulted in a significantly greater rate of dietary action taken to prevent new onset kidney stones.

CONCLUSIONS: Though demographic factors may be associated with greater awareness of myths related to diet and kidney stones, prior history of stones has the greatest impact on overall awareness of both facts and myths. Regardless of demographics or prior stones, information communicated from physicians led to more action taken by patients. Therefore, physicians should continue to educate all patients on verified dietary measures to reduce the spread of misinformation and promote kidney stone prevention.

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ABSTRACT 73 TYPE I INTERFERON MODULATES LANGERHANS CELL ADAM17 TO PROMOTE PHOTOSENSITIVITY IN LUPUS. Thomas Li1, Keila Veiga2, Noa Schwartz2, Yurii Chinenov2, David Oliver2, Jose Lora2, Ali Jabbari3, Yong Liu4, William Shipman2, Marvin Sandoval2, Isabel Sollohub2, William Ambler2, Bikash Mishra2, Lionel Ivashkiv2, Mehdi Rashighi5, James Krueger3, Niroshana Anandasabapathy4, Carl Blobel2, Theresa Lu2.

1 Medical Education. 1Icahn School of Medicine at Mount Sinai, 2Hospital for Special Surgery, 3Rockefeller University, 4Weill Cornell Medical College, New York, NY. 5University of Massachusetts Medical School, Worcester, MA. BACKGROUND: Anifrolumab (anti-IFNAR1) was developed and recently FDA-approved for lupus, an autoimmune disease characterized by photosensitivity that triggers skin inflammation with ambient ultraviolet radiation (UVR). However, pathogenic mechanisms by which type I interferon (IFN-I) drives lupus and other interferonopathies remain poorly understood. Langerhans cells (LCs) limit photosensitivity via a disintegrin and metalloprotease 17 (ADAM17)-mediated shedding and provision of soluble epidermal growth factor receptor (EGFR) ligands. Here, we asked if an IFN-I-LC ADAM17 axis contributes to lupus cutaneous disease.

METHODS: To assess IFN-I levels, we performed microarray and bulk RNA-sequencing. To assess LC ADAM17 activity and expression, we performed flow cytometry. To assess skin health and the relationship between IFN-I and EGFR signaling, we performed functional assays. To assess statistical significance, paired and unpaired Students t-tests were conducted.

RESULTS: Differential pathway analyses showed that an IFN-I-related pathway was among the most upregulated in non-lesional lupus skin. This pathway was comprised of several upregulated IFN-stimulated transcription factors, including IRF 1,2,7,8, and 9. IFN-I reduced LC ADAM17 activity by nearly 40% (p<0.01) with a 9% reduction in surface levels (p<0.01) in vitro. In vivo, there was a 60% decrease in activity (p<0.001) and a 9% decrease in expression (p<0.001). In the MRL-Faslpr lupus model, there was a 45% reduction in LC ADAM17 activity compared to the control MRL mouse (p<0.001). Anti-IFNAR1 restored MRL-Faslpr LC ADAM17 activity (p<0.05), but not expression (p=0.67), to that of the control. Anti-IFNAR1 also reduced UVRinduced skin inflammation by 30% (p<0.05) and epidermal permeability by 50% (p<0.05). The TLR7/8 agonist imiquimod induced lupus-like photosensitivity in mice. Anti-IFNAR1 mitigated photosensitivity in an imiquimodtreated wildtype mouse (p<0.05), while it was unable to alleviate photosensitivity in mice lacking LC ADAM17 (p=0.49).

CONCLUSIONS: Here, we show that IFN-I mediates photosensitivity by inhibiting LC ADAM17. Murine and human lupus skin share high IFN-I environments, and IFN-I inhibits LC ADAM17. Anti-IFNAR1 in lupus models restores LC ADAM17 function and reduces photosensitivity in EGFR- and LC ADAM17-dependent manners.

Our findings delineate a mechanism for IFN-I-mediated cutaneous pathogenesis and a potential way by which anifrolumab limits cutaneous disease.

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ABSTRACT 74 PREVALENCE OF GERMLINE CLONAL HEMATOPOIESIS OF INDETERMINANT POTENTIAL (CHIP) MUTATIONS IN INDIVIDUALS WHO DEVELOP HEMATOLOGICAL MALIGNANCIES. Matthew Liebers1, Alessandro Lagana2, 1Medical Education, 2Hematology/Oncology.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Genetic alterations associated with Clonal Hematopoiesis of Indeterminant Potential (CHIP) have been shown in recent studies to be a precursor to the development of certain hematological malignancies, such as Acute Myelogenous Leukemia (AML). Multiple myeloma (MM) is a heterogeneous hematologic malignancy and is the second most prevalent blood cancer. It is defined by an array of molecular subtypes, as well as diverse mutational and expression profiles. We analyzed a large genomic dataset to elucidate the presence and downstream implications of certain CHIP mutations in the development and diagnosis of MM along with several other hematological malignancies.

METHODS: We leveraged the BIOME Biobank database, which represents a large (>25,000 patient) cohort of Mount Sinai Health System patients who received whole exome sequencing of whole blood. We narrowed our initial CHIP mutation list to 7 genes: DNMT3A, ASXL1, TET2, JAK2, TP53, IDH1 and IDH2.

Among these genes, we flagged any instance of a single (or more) non-reference read at any exonic allele.

We also evaluated the ICD-9 and ICD-10 diagnoses of patients, including the aforementioned hematological malignancies. We then included VEP pathogenicity annotation of each allele (low, medium, high), rolled up to the patient level.

RESULTS: At first glance, the data indicate that mutations of varying pathogenicity seem to occur with similar rates whether or not an individual gets diagnosed with a hematological malignancy or not. However, patients who harbor multiple CHIP mutations at once, particularly of medium or high pathogenicity, are more highly represented among patients who developed hematological malignancies. Of note, the only patient in BIOME that has 3 high pathogenic CHIP mutations is a MM patient. Finally, a small cohort of patients (n=6) with pathogenic ASXL1 mutations had diagnoses of various aneurysm and connective tissue related problems, which could represent a previously unreported association.

CONCLUSIONS: Multiple high pathogenicity CHIP mutations may predispose to developing hematological malignancies, such as MM. The presence of individual and/or lower pathogenicity CHIP mutations seems to be common in the broader population, without a clear association with hematological malignancy. More work needs to be done in this area, both in evaluating additional populations and in further understanding the true effects of individual variants within the broader CHIP-related family.

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ABSTRACT 76 GENERATION OF IPSC MODELS FOR RASOPATHY INDUCED CARDIAC PATHOLOGIES. Clifford Liu1, Nelson Rodriguez2, Simon Ng2, Bruce Gelb2. 1Medical Education, 2Pediatrics.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. RASopathies are a class of developmental syndromes caused by germline mutations in the RAS-MAPK pathway. While these syndromes can cause a variety of medical issues, some of the most consequential are the development of hypertrophic cardiomyopathy (HCM) and pulmonary valve stenosis. While little is known about the mechanisms that drive pulmonary valve stenosis, previous work by our lab and others have identified both cell autonomous and non-autonomous mechanisms that contribute to HCM, including paracrine signaling from both cardiac fibroblasts and endocardial cells. Interestingly, although many alleles in the RAS-MAPK pathway have been associated with HCM, the disease burden is not evenly distributed. In fact, gain-of-function associated PTPN11 variants in Noonan syndrome (NS) are negatively associated with HCM (6% vs 26% non-PTPN11 NS) while gain-of-function RAF1 variants are positively associated (75% vs 20% overall). Furthermore, loss-of-function variants of PTPN11 in Noonan syndrome with multiple lentigines (NSML) is highly associated with HCM (80%).

To model the development of HCM and valve stenosis resulting from RASopathies, we are using patientderived and CRISPR-edited iPSCs and differentiating them into cardiomyocytes, cardiac fibroblasts, and endocardial cells that can undergo endocardial-mesenchymal transition to become valvular interstitial cells.

We hypothesize that each of these cell types will have alterations in signal transduction that are responsible for HCM and valve stenosis. Furthermore, changes in signal transduction will differ between alleles strongly associated with HCM and those that do not generally cause HCM in the RASopathies.

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ABSTRACT 77 VISUAL DEFICITS IN CRANIOSYNOSTOSIS: GEOMETRIC MORPHOMETRIC ANALYSIS OF VISUAL STRUCTURES. Helen Liu1, Abigail Katz1, Peter Taub2. 1Medical Education, 2Surgery.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Non-syndromic unilateral coronal craniosynostosis (UCS) is a rare congenital disorder.

UCS results from the premature fusion of one of the skull’s coronal sutures between the frontal and parietal bones, leading to complex morphologic changes in the shape of the calvarium and skull base. Previous studies have suggested associations between visual deficits and UCS. However, few studies have confirmed the prevalence rate and quantified the difference in size and shape of important visual structures (orbit, superior orbital fissure and optic canal) in craniosynostosis. Prior studies have used finite element analysis to quantitatively simulate calvarial growth in craniosynostosis. For this study, we will use novel geometric morphometric analysis to understand the intrinsic shape of the skull and its contents, which is paramount in describing bone dysmorphogenesis.

OBJECTIVE: The primary goal of this proposal is to determine whether there is a significantly higher prevalence of ophthalmologic abnormalities in UCS and whether there is a difference in the size of important visual structures in craniosynostosis to elucidate possible etiologies for visual abnormalities in UCS. METHODS: To characterize the three-dimensional dysmorphogenesis in UCS, CT scans were converted into three-dimensional mesh models and landmarks of the visual structures were placed on each model. After generating approximate formulas, overall anatomical morphologies were characterized using Generalized Procrustes Analysis, and specific ocular landmarks were measured. Statistical analysis was used to compare the differences between UCS patients and normal healthy controls.

RESULTS: Patients with craniosynostosis are much more likely to have vision problems (77.8%). Compared to prevalence rates in the general population, prevalence of refractive errors such as astigmatism, anisometropia, amblyopia and eye cranial nerve involvement including trochlear nerve palsy were much higher in our UCS population (all p <0.0001). Our analysis found that patients with craniosynostosis had significantly larger contralateral orbital volumes (left UCS p < 0.05, right UCS = 0.05). Among UCS patients, there was an association between having a larger ipsilateral optic foramen and astigmatism (left UCS p=0.24, right UCS p <0.05). Patients with trochlear nerve involvement had significantly smaller contralateral foramen ovales than healthy controls (left UCS p < 0.001, right UCS p < 0.01).

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ABSTRACT 78 CLINICAL DECISION MAKING FOR PIGMENTED SKIN LESIONS: A COMPARISON BETWEEN DERMOSCOPY AND ELECTRICAL IMPEDENCE SPECTROSCOPY ACROSS DIFFERENT LEVELS OF TRAINING. Isabel Lopera1, Shayan Owji2, Jonathan Ungar2, Benjamin Ungar2. 1Medical Education, 2 Dermatology. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Dermatologists rely on inspection and dermoscopy to guide clinical decision making for pigmented skin lesions (PSLs). This approach has drawbacks: false positive diagnoses lead to unnecessary excisions and increases in costs, while false negative diagnoses can leave malignant lesions undiagnosed.

Electrical impedance spectroscopy (EIS) is a noninvasive, diagnostic tool to aid clinicians in biopsy decisions.

EIS utilizes a low voltage electrode to apply painless electrical currents to PSLs and measures differences in electrical impedance to generate scores correlating to risk of malignancy.

OBJECTIVE: To better understand the clinical utility of EIS, we studied the effect it has on clinical decisions for PSLs compared to dermoscopy.

METHODS: 38 dermatologists, 25 dermatology residents, and 26 medical students were tested on their biopsy decisions and diagnostic accuracy for 24 PSLs via an online survey. 12 of these lesions were randomly assigned as clinical and dermoscopic images, the other 12 were presented as clinical images with EIS scores.

Respondents were asked if they would biopsy and to select their expected diagnosis. The sensitivity and specificity of decisions for melanoma and dysplastic nevi were determined. Images were histologically confirmed. Metrics were stratified for level of training.

RESULTS: 1740 clinical decisions were made. For clinical and dermoscopic images, the decision to biopsy was made on 541 of 862 lesions vs 422 of 878 lesions when provided a clinical image and EIS score (62.8% vs. 48.1%; p<0.001). Biopsy decisions made based on clinical morphology and dermoscopy demonstrated a sensitivity of 66% (95% CI= 62-70.2), while decisions made based on clinical morphology and EIS had a sensitivity of 75% (95% CI=71.4-78.8). The overall specificity of biopsy decisions based on clinical morphology and dermoscopy was 40% (95% CI=34.5-44.7), while biopsy decisions based on clinical morphology and EIS had a specificity of 70% (65.5-75). Biopsy decisions made by attendings exhibited similar sensitivities for both EIS and dermoscopy (81% vs. 81%). Attendings also saw the greatest increase (68% vs. 35%) in specificity of decisions made with EIS when compared to dermoscopy. Residents and medical students saw significant increases in both the sensitivity and specificity of their decisions with EIS as compared to dermoscopy. EIS shows greater sensitivity and specificity than dermoscopy alone and could positively impact clinical decision making.

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ABSTRACT 79 TRANSITION OF CARE IN CONGENITAL HEART DISEASE: A SINGLE CENTER EXPERIENCE AT A LARGE URBAN TERTIARY CARE SETTING. Christine Lopez1 , Brittany Glassberg2, Alexandra Dembar3, Maria Riasat3, Ali Zaidi4.

1 Medical Education, 3,4Medicine. 1,3,4Icahn School of Medicine at Mount Sinai, New York, NY, 2 Perelman School of Medicine, Philadelphia, PA. BACKGROUND: The term “transition of care” (TOC) refers to the continuity of health care during movement from one healthcare setting to another as care needs change during a chronic illness. For young people with chronic illnesses, successful TOC often refers to the process of moving from the pediatric to an adult healthcare setting. This process can often be challenging; however, successful TOC is essential for health outcomes. Lack of successful TOC from pediatrics to adult medicine puts young adults with CHD at increased risk for morbidity and mortality. Large proportions of young pts. with CHD are lost to follow-up (LTF) or experience gaps in care after leaving pediatric cardiology (PC) due to lack of appropriate TOC. OBJECTIVES: To describe and evaluate clinical, social and demographic factors related to TOC or LTF in a large tertiary care facility in pts. with CHD. METHODS: Patients were identified using Mount Sinai Data Warehouse utilizing the electronic medical record (EMR) (Epic). Inclusion criteria included: congenital heart defects, age ≥ 15 years seen in the ambulatory PC clinic between 2013 and 2014. Exclusion criteria included: deceased patients. Clinical and demographic variables were collected by retrospective chart review for each pt. meeting inclusion criteria.

Patient’s charts were reviewed between 2015-2021 to determine if they were a) still in PC care, b) transitioned to adult cardiology (AC)/ACHD or c) LTF. Independent predictors for successful TOC or LTF was performed using a Chi-Squared analysis.

RESULTS: Total of N=322 patients were included. 49% (N=159) had successful TOC from PC to AC/ACHD, 22% (N=70) remained with PC and 29% (N=93) were LTF. More patients with successful TOC to AC/ACHD had complex lesions (21%) and had seen PC more than once a year (28%). The majority of pts. LTF were either uninsured or had public insurance (Medicaid) (62%), had moderately complex CHD (64%) and saw PC less than annually (30%).

CONCLUSION: In this setting, successful TOC from PC to AC/ACHD happened infrequently in pts. with CHD. Pts. with severely complex CHD lesions and visits more than once a year to the PC had successful TOF. Pts. with public insurance/Medicaid, as well as moderately complex CHD lesions were LTF. Lack of successful TOC even in large tertiary care centers begins during early adolescence despite pts. being in contact with healthcare providers. Efforts need to be made to improve TOC to avoid long term care in patients with CHD.

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ABSTRACT 80 CHARACTERIZING NON-RESPONDERS TO AN HIV DISCLOSURE INTERVENTION FOR CAREGIVERS OF CHILDREN WITH HIV: A POST-HOC ANALYSIS OF A CLUSTER RANDOMIZED TRIAL IN ELDORET, KENYA. Liza Magill1, Aaron Baum2, Rachel Vreeman2. 1Medical Education. 1Icahn School of Medicine at Mount Sinai, 2 Arnhold Institute for Global Health, New York, NY. BACKGROUND: Despite World Health Organization recommendations that HIV disclosure to children be completed by age twelve, many adolescents do not know their HIV status. The HADITHI study, a clusterrandomized trial of 280 children living with HIV aged nine to fourteen and their caregivers in Kenya, showed that a two-year counseling intervention increased rates of caregiver disclosure to their children; however, 22% of caregivers still chose not to disclose.

OBJECTIVES: To identify characteristics predicting caregiver non-responsiveness to the intervention.

METHODS: This post-hoc analysis included 60 caregiver-child dyads who participated in the HADITHI intervention and were non-disclosed at baseline. The cohort was first randomly split into equal training and test datasets. In the training data, a penalized logistic regression model with lasso regularization identified the most important predictors of non-responsiveness. The dependent variable was disclosure up to two years after baseline. Independent variables included 80 demographic, psychosocial, and clinical covariates. In the testing data, predictors were selected using validation alpha standard error (ASE). We repeated the above sample splitting procedure 1000 times with replacement, and the average value of ASEs was calculated to produce the best regularization model.

RESULTS: Two predictors—caregiver isolation and child length of time on antiretroviral medication (ARVs)— were retained in the best fitting model. While 44 of 52 (84.6%) non-isolated caregivers disclosed HIV status, only 3 of 8 (37.5%) isolated caregivers disclosed. Caregiver isolation was defined as responding “ever happened” to the following prompt: “Because the child or someone else in my family has HIV or because I have HIV, I am isolated or avoided by others.” The mean (SD) length of time on ARVs for children who were disclosed to was 1.3 (1.5) years, while that of those who were not disclosed to was 2.5 (2.4) years. The model’s discrimination between caregivers’ disclosure status in the entire dataset was strong, with area under the curve= 81.21%.

CONCLUSIONS: Caregiver isolation and a child being on ARVs for longer time were correlated with Kenyan caregiver’s likelihood of not disclosing their child’s HIV status to them after completing a disclosure intervention. These findings have implications for specialists seeking to tailor disclosure interventions to improve caregiver-child dyad responsiveness.

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ABSTRACT 81 PARENTAL HESITANCY: TO VACCINATE OR NOT TO VACCINATE CHILDREN AGAINST SARS-COV-2, A SYSTEMATIC REVIEW. Simran Malhotra1, Kevin Griffee1, Roxanne Martin2, Ashley Chory2, Rachel Vreeman2. 1Medical Education. 1Icahn School of Medicine at Mount Sinai, 2Arnhold Institute for Global Health, New York, NY. BACKGROUND: As of November 2021, the FDA authorized emergency use of the Pfizer SAR-CoV-2 vaccine for children ages 5-11 years old, and 12-17 year-olds have been able to get vaccinated since August 2021.

Efforts to end the COVID-19 pandemic must include vaccination for children under 18 years—who make up a quarter of the world’s population. To achieve widespread pediatric vaccination, we must understand parents and caregivers’ knowledge, attitudes, and beliefs (K/A/B) regarding vaccines for SARS-CoV-2.

OBJECTIVE: To assess the K/A/B of parents/caregivers/guardians (caregivers) regarding the vaccination of their children and adolescents (youth) against SARS-CoV-2.

METHODS: Using PRISMA guidelines, online databases (PubMed, Scopus, CINAHL, and Web of Science) were searched for peer-reviewed literature and/or gray literature on 9 July 2021. Two researchers screened abstracts and titles followed by a full-text review; a third researcher resolved any discrepancies. The inclusion criteria were: (1) Studies published in English (2) Must evaluate a study that has at least one measurement of caregiver’s willingness to vaccinate their youth against SARS-CoV-2, (3) Must include at least one quantitative/qualitative outcome, and (4) Participants must include the caregiver of at least one child under the age of 18.

RESULTS: 32 articles met the inclusion criteria. Vaccine acceptability among caregivers differed among countries and within countries. 29 articles were single-country studies, most commonly in China, US and Turkey. These three countries saw a wide range of SARS-CoV-2 vaccine acceptability, ranging from 10.4% to 96.0%. The three multi-country (from dissimilar regions) articles showed a narrower range of 65.0% to 69.2%. Six out of seven articles found that caregiver sex affected vaccine acceptability for youth, with mothers more vaccine hesitant than fathers. Previous childhood and influenza vaccination were predictors for vaccine acceptability. Seventeen articles showed that having received routine childhood and influenza vaccines were associated with caregivers supporting COVID vaccination of their youth.

CONCLUSION: Given the variability of vaccine acceptability among caregivers due to country, sex and previous vaccination behaviors, efforts to increase vaccination can be cognizant of the context in which the COVID vaccine is advertised, as it influences caregiver vaccine intent for youth.

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ABSTRACT 82 BREAKING OF IMMUNE TOLERANCE IN DOWN SYNDROME: A TRIAD OF CYTOKINES, ACTIVATED T CELLS, AND EXTRAFOLLICULAR B CELLS. Louise Malle1, Roosheel S. Patel2, Sofija Buta2, Ashley Richardson2, Vanessa Barcessat3, Justin Taft2, Paul Bastard4, Julie Samuels5, Rebecca Trachtman5, Jean-Laurent Casanova6, Luigi Notarangelo7, Sacha Gnjatic3, Douglas Bush5, Dusan Bogunovic2. 1Medical Education, 2Microbiology, 5Pediatrics. 1,2,3,5Icahn School of Medicine at Mount Sinai, New York, NY, 4INSERM, 6Rockefeller University, 7NIAID, NIH. Down syndrome (DS) presents with a constellation of cardiac, neurocognitive, and growth impairments. More recently, immune features have become apparent and are exceedingly common. These include increased susceptibility to infections concomitant with elevated rates of autoinflammatory and autoimmune diseases such as thyroiditis, type 1 diabetes, celiac disease, and alopecia aerata. In this study, we used a systemsimmunology approach to characterize the soluble and cellular immune responses of individuals with DS. Firstly, we identified a global and persistent elevation of cytokines at steady-state in DS, with upregulation of up to 22 cytokines in two-thirds of individuals. The IL-6-STAT3 axis was basally activated in CD4 T cells, which was reversible either with JAK inhibitors or anti-IL6R treatment ex vivo. Secondly, we detected a pronounced extrafollicular B cell response characterized by expression of CD11c, T-bet, and downregulation of CD21. This was accompanied by elevation of plasmablast frequency in DS peripheral blood, which we also observed in vitro when healthy donor naïve B cells differentiated into plasmablasts in the presence of DS plasma. Finally, this aberrant B cell response was accompanied by the detection of 365 self-reactive antibodies in the plasma of individuals with DS when compared to age-matched controls. These autoantibodies were distinct from those in patients with SLE and APS-1 but overlapped with those identified in IPEX patients. These autoreactive antibodies not only targeted the GI tract, the pancreas, the thyroid, and the central nervous system, but also the immune system itself, suggestive of a feed-forward loop of immune dysregulation. Together, these data point to an autoimmunity-prone state in DS, where a steady-state “cytokinopathy,” hyperactivated CD4 T cells, and extrafollicular B cell activation all contribute to the breaking of self-tolerance. Our findings shed light on the immunological disturbances that underlie the clinical manifestations of the syndrome. Furthermore, these data open possible therapeutic avenues as we demonstrate that T cell activation is resolved not only with broad immunosuppressants like Jak inhibitors but also with a more tailored approach of anti-IL6R inhibition.

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ABSTRACT 83 EFFECTS OF A HISTORY OF HEADACHE AND MIGRAINE TREATMENT ON BASELINE NEUROCOGNITIVE FUNCTION IN YOUNG ATHLETES. Lily McCarthy1, Theodore Hannah2, Adam Li2, Alexander Schupper2, Eugene Hrabarchuk2, Roshini Kalagara2, Muhammad Ali2, Alex Gometz3, Mark Lovell4, Tanvir Choudhri2. 1Medical Education, 2 Neurosurgery, 4Neurology. 1,2Icahn School of Medicine at Mount Sinai, New York, NY, 3Concussion Management of New York, 4University of Pittsburgh, Pittsburgh, PA. BACKGROUND: Despite the prevalence of sports-related concussion (SRC) in young athletes, the impact of a pre-injury history of headache and migraines on neurocognitive function at baseline is poorly understood.

While some studies have found a history of headache and migraines results in worse baseline performance, others have reported individuals perform comparably or better relative to controls. Expanding awareness of specific neurocognitive differences in these patients has the potential to inform clinical decisions before and after SRC. We analyzed the effects of having been previously treated for a headache or migraine on baseline ImPACT composite scores in young athletes.

OBJECTIVE: To enhance understanding of baseline (pre-injury) neurocognitive function in young athletes with prior history of headache or migraine treatment.

METHODS: This study involved a retrospective, cross-sectional design. A total of 11,563 baseline ImPACT tests taken by 7,453 student-athletes ages 12-22 between 2009 and 2019 were reviewed. The first baseline test was included. There were 960 subjects who reported a history of treatment for headache and/or migraine (HAT) and 5,715 who did not report a history of treatment for headache and/or migraine (no-HAT).

The HAT group included all subjects who self-reported a history of treatment for migraine or other type of headache on the standardized questionnaire. Linear mixed effects models were used to assess differences in baseline composite scores between groups while controlling for significant demographic differences and symptom burden.

PRELIMINARY RESULTS: Univariate analyses demonstrated HAT was associated with increased symptoms (β=1.4, 95% CI: 1.1-1.6, p < 0.0001), decreased visual memory (β=-1.3 95% CI: -2.2 to -0.38, p = 0.006), and increased visual motor speed (β=0.7, 95% CI: 0.22-1.2, p = 0.004) composite scores. Baseline scores for verbal memory, reaction time, and impulse control were not significantly different between groups. Linear mixed effects models demonstrated similar results for symptom burden and visual memory with HAT patients having greater symptom burden (β=1.1, 95% CI: 0.8-1.4, p < 0.0001) and lower visual memory (β=-1.5, 95% CI: -2.5 to -0.6, p = 0.002). There was no difference in visual motor speed (β=0.4, 95% CI: -0.05-0.90, p = 0.081) or the other composite scores. These findings suggest that prior treatment for preexisting chronic headaches may affect baseline performance on ImPACT.

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ABSTRACT 84 THE DEVELOPMENT OF AN RT-PCR ASSAY AND A NEWCASTLE DISEASE VIRUS (NDV) REPORTER VIRUS FOR USE IN PHASE 1 CLINICAL TRIALS EVALUATING NDV-VECTORED VACCINES AGAINST COVID-19.

Stephen McCroskery1, Irene González-Domínguez2, Nicholas Lemus2, Peter Palese2, Weina Sun2.

1 Medical Education, 2Microbiology. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: We have developed a Newcastle disease virus (NDV)-vectored vaccine expressing a membrane-bound SARS-CoV-2 spike protein modified to contain stabilizing mutations (six prolines; hexapro –HXP) and a deletion of the polybasic cleavage site. This vaccine (NDV-HXP-S) is stable at 4°C and can utilize the pre-existing influenza vaccine manufacturing infrastructure for inexpensive and rapidly scalable production. These qualities make NDV-HXP-S ideal for production at sites around the globe including lowmiddle income countries and is in Phase 1/2 clinical trials in an inactivated platform in several countries. An upcoming Phase 1 trial at Mount Sinai will evaluate NDV-HXP-S administered in a live, intranasal format.

OBJECTIVE: To create tools in support of the NDV-HXP-S clinical trial. To assay for the shedding of vaccine virus from clinical trial subjects, an RT-PCR assay was developed. Additionally, a Click Beetle Red luciferase (CBred)-expressing NDV was engineered for use in animal model studies to examine the biodistribution of NDV administered nasally.

METHODS: Several RT-PCR parameters including primer pairs and annealing temperature were evaluated.

The assay’s dynamic range and limit of detection was determined and validation was performed using human nasal swabs spiked with NDV-HXP-S. The NDV-CBRed rescue plasmid was cloned and the virus was rescued using standard rescue techniques. The expression of the rescued virus was confirmed via RTPCR and sequencing of the transgene as well as luciferase assays performed on infected mammalian cell monolayers. As a proof of principle, lung homogenates harvested at several timepoints from mice intranasally infected with NDV-CBRed were subjected to the luciferase assay.

RESULTS: Following optimization and finalization of the assay parameters, the RT-PCR assay was found to have an 8-log dynamic range with a limit of detection of ~3 plaque forming units (PFU). In validation experiments, the assay yielded positive results in all human nasal swab samples spiked with NDV while negative controls tested negative. The CBRed-expressing NDV was successfully rescued and found to strongly express its transgene following infection in mammalian cell culture. Lung homogenates of mice infected with NDV-CBred at 24 and 48 hours post-infection had a 3.33 and 1.57 fold increase in luciferase signal relative to baseline, respectively.

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ABSTRACT 85 DEVELOPING A DECISION SUPPORT TOOL TO DETERMINE THE OPTIMAL NUMBER OF BANKED EMBRYOS TO ACHIEVE DESIRED FAMILY SIZE. Zahava Michaelson1, Devora Aharon2, Alan Copperman2. 1Medical Education, 2Obstetrics, Gynecology, and Reproductive Science. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Following in vitro fertilization (IVF), patients desiring pregnancy may proceed with embryo transfer or first retrieve more oocytes and bank more embryos to increase their chances of live births (LB).

Females ≤35 years old are more likely to achieve euploid embryos and LB from IVF, but carrier age does not affect LB rate of euploid embryos. It is, as such, advisable to proceed with retrievals until the optimal number of euploid embryos has been banked to obtain a desired family size. This study aims to identify factors contributing to the probability of LB (p(LB)) after single euploid embryo transfer (SEET) and develop a model to determine patient-specific optimal numbers of banked euploid embryos.

RESEARCH QUESTION: Which factors contribute to p(LB) following SEET and what the chances of 1 or 2 LB based on the number of banked euploid embryos?

METHODS: All SEET cycles from 2011-2020 were included in a single-center retrospective study. A model built to predict the chances of 1 and 2 LB based on the number of SEETs incorporated baseline and cycle characteristics. A multivariable random-intercept logistic model computed p(LB) after a single SEET and a binomial probability model computed the probability of at least 1 or 2 LB as a function of p(LB) and number of SEET. Variable selection was performed using backward selection based on Bayesian Information Criterion.

RESULTS: 7,434 SEET cycles of 4,586 patients were included. Univariate analysis showed oocyte age, BMI, AMH, BAFC, gravidity, endometrial thickness (EMT), endometrial pattern, uterine factor (UF), high quality embryo (HQE), and biopsy day (BD) as significantly (p≦0.1) associated with LB. Variables included in the final random-intercept logistic model were: UF (OR=0.62, 95% CI 0.52-0.72, p<.0001), HQE (OR=1.46, 95% CI 1.29-1.65, p<.0001), BD (6 vs 5: OR=0.71, 95% CI 0.64-0.80, p<.0001; 7 vs 5: OR=0.22, 95% CI 0.16-0.30, p<.0001), and EMT (7.6-8.5 vs ≤7.5mm: OR=1.47, 95% CI 1.21-1.79, p<.0001; 8.6-10.5 vs ≤7.5mm: OR=1.71, 95% CI 1.41-2.06, p<.0001; ≥10.6 vs ≤7.5mm: OR=2.06, 95% CI 1.67-2.54, p<.0001).

CONCLUSION: Our model shows that once a euploid embryo is obtained, p(LB) depends mainly on embryo quality and endometrial factors. The model incorporates patient- and embryo-specific factors to generate individualized probabilities of 1 or 2 LB based on the number of euploid embryos frozen, and incorporates cycle-specific factors, once available, to further improve precision of predictions.

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ABSTRACT 86 CULTURAL DIMENSIONS OF LONG-TERM HEALTH IMPACTS OF WORLD TRADE CENTER ENVIRONMENTAL EXPOSURES: A DISCOURSE ANALYSIS OF CONGRESSIONAL TESTIMONY. Alli Morgan1, Jacob Appel2. 1Medical Education, 2Psychiatry. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. In the years following the September 11, 2001 attacks, survivors, first responders, and nearby residents began to experience far more serious health effects than the “World Trade Center cough” that initially affected first responders from exposure to toxic dust and fires that burned in the days and months following the collapse of the towers. Those exposed face disproportionately high rates of respiratory, neurological, and gastrointestinal illness and cancers, yet linking these conditions to World Trade Center (WTC) exposure has been far from straightforward. Toxics challenge the linear cause and effect logic undergirding clinical medical practice, with symptoms and diagnoses emerging months or years after the initial exposure. In attempts to garner support for bills to allocate federal funding for the screening, monitoring, and treatment of those impacted by WTC exposures, several Senate and Congressional hearings have been held over the last twenty years.

This study draws upon the publicly available Congressional testimony of survivors and first responders with long term health effects from WTC environmental exposures in attempts to characterize the positions of persons with diagnoses subject to clinical and political instability. For these patients, linking their health conditions to WTC exposure remains a constant struggle fraught with intense bureaucratic, political, and scientific barriers to recognition. By employing Foucauldian discourse analysis, this study seeks to examine how testimonies reflect broader political and cultural values around health, compensation, and victimhood.

In analysis of the testimonial data, we found that over time, discourse around access to monitoring and clinical care shifted from notions of “innocence” to those of “service” and “duty.” Survivors who were not volunteers or affiliated with the NYPD or FDNY lacked access to this dominant narrative and were largely excluded from providing formal public testimony. Rather than follow the narrative conventions of “toxic discourse” (Buell 1998), WTC testimonies invoke militaristic sentiments of deservedness via sacrifice, a mode of testimony we are terming, “toxic nationalism.” Rather than function in the counterhegemonic mode that “toxic discourse” demands, “toxic nationalism” forges Ground Zero as war zone, and with it narrows who registers legally and socially as a victim.

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ABSTRACT 87 THE EFFICACY OF NETARSUDIL - POST APPROVAL REALITY. Oluwafeyikemi Okome1, Jane Song2, Jun Lin3, Sze Wong4. 1Medical Education, 2,3,4Ophthalmology.

1,3 Icahn School of Medicine at Mount Sinai, New York, NY, 2CareMount Medical, Mount Kisco, NY, 4 New York Eye and Ear Infirmary of Mount Sinai, New York, NY. OBJECTIVE: To evaluate the efficacy of netarsudil 0.02% ophthalmic solution dosed once daily before bed (q.h.s.) in reducing intraocular pressure (IOP) in eyes on multiple glaucoma medications.

METHODS: This was a retrospective cohort study. Patients came from the New York Eye and Ear Infirmary of Mount Sinai (NYEEI) resident glaucoma clinic prescribed with netarsudil between November 2020 and February 2021. Subject eyes recruited were diagnosed with glaucoma and had IOP above target despite being on ≥ 2 ocular hypotensive agents. Subject eyes were excluded if they were unable to tolerate or adhere to netarsudil for a period of 4-8 weeks after initiation of therapy. Main Outcome Measures: The IOP-reducing effect of netarsudil after 4-8 weeks of therapy, with comparisons made between types of glaucoma and between eyes that did and did not have prior glaucoma surgery. The changes in IOP were then assessed via t-test and interpreted as a percentage change in IOP. RESULTS: Netarsudil was prescribed for 222 eyes. 50 eyes were excluded from analysis due to lack of adequate follow up or inability to adhere to therapy, leaving 172 eyes for analysis. 114 eyes had open angle glaucoma (OAG) and 17 had mixed mechanism glaucoma (MMG). The mean baseline IOP for eyes with OAG and those with MMG were 21.1 ± 5.8 mm Hg and 19.4 ± 5 mm Hg, respectively. After 4-8 weeks of treatment the mean IOP for eyes with OAG and those with MMG were 16.3 ± 4.8 mm Hg (p < 0.001) and 16.2 ± 4.6 mm Hg (p < 0.001), respectively. 110 eyes had prior glaucoma surgery and 62 had not. Mean baseline IOPs for eyes that did and did not have glaucoma surgery were 20.7 ± 5.9 mm Hg and 21.6 ± 5.7 mm Hg, respectively. After 4-8 weeks of treatment with netarsudil, the mean IOPs were 16.4 ± 5 mm Hg (p < 0.001) and 15.4 ± 4.5 mm Hg (p < 0.001), respectively. Netarsudil was discontinued in 15 eyes (8.7%) at 12 months after initiating therapy.

CONCLUSIONS: This study demonstrates that netarsudil is efficacious as an ocular hypotensive in eyes already on multiple glaucoma medications, regardless of the type of glaucoma or whether prior glaucoma surgery was performed. These findings further suggest that when taken as prescribed, netarsudil has the potential to delay the need for or potentially avoid incisional glaucoma surgeries for patients who are able to tolerate the drug.

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ABSTRACT 88 HEALTHCARE UTILIZATION AND SPENDING AMONG HOMEBOUND OLDER ADULTS, 2011-17.

Benjamin Oseroff1, Claire Ankuda2, Evan Bollens-Lund2, Melissa Garrido3, Katherine Ornstein2.

1 Medical Education, 2Geriatrics and Palliative Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, NY, 3Boston University School of Public Health, Boston, MA. BACKGROUND: Homebound older adults have complex social, medical, and financial needs, but little is known about their healthcare use and spending.

OBJECTIVE: To characterize healthcare utilization and spending among homebound older US adults.

METHODS: We used data from the first six waves of the National Health and Aging Trends Study (NHATS) survey linked to Medicare Fee-For-Service (FFS) data from 2011-17. Observations were drawn from a nationally representative sample of noninstitutionalized Medicare beneficiaries 70 years and older with Medicare FFS coverage. We identified individuals as homebound if they reported never or rarely (no more than 1 day/week) leaving the home in the last month. We compared survey-weighted rates and adjusted marginal differences of inpatient, outpatient, and emergency department utilization and spending 12 months post-interview by homebound status. Potentially preventable hospitalizations were also identified using ambulatory care sensitive conditions.

RESULTS: Of the 18,889 person-year observations of 6,468 unique respondents in the sample, 1,537 (n=991 unique respondents) were identified as homebound. Homebound individuals were more likely to be older (mean age 83.8 years vs 78.3 years, p < 0.001), female (74.3% vs 55.6%, p < 0.001) and less likely to be White non-Hispanic (74.7% vs 86.4%, p < 0.001). Compared to the non-homebound, homebound older adults had higher annual rates of all-cause hospitalization (39.8% vs. 19.8%, p < 0.05[AC1]), preventable hospitalization (14.8% vs 5.0 %, p < 0.05), and emergency department visits (54.0% vs 32.5%, p <0.05). Despite being more medically complex, homebound older adults were less likely to access primary care (60.9% vs 71.9%, p < 0.05) and specialist care (61.0% vs 74.9%, p < 0.05) than the non-homebound. On average, homebound older adults incurred an additional $11,346 in total Medicare spending per year (p < 0.05) and accounted for a disproportionate share of Medicare spending among those 70 and older (11% of total Medicare spending versus 6% of population). In models adjusting for demographic, clinical, and geographic characteristics, homebound status was associated with a 9.8 percentage point (p < 0.05) decrease in the likelihood of having an annual primary care visit and a 13.6 percentage point (p < 0.05) decrease in the likelihood of having a specialist visit each year.

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ABSTRACT 89 IMMUNOTHERAPY EFFECTIVENESS IN STAGEIV NON-SMALL CELL LUNG CANCER ACCORDING TO PERSONAL AND CLINICAL CHARACTERISTICS. Krishna Patel1, Naomi Alpert2, Emanuela Taioli2. 1Medical Education, 2 Population Health Science and Policy. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: For patients with late-stage non-small cell lung cancer (NSCLC), immunotherapy can be less toxic, more targeted, and more effective than chemotherapy. Medial overall survival (OS) for late-stage NSCLC patients receiving a chemoimmunotherapy combination is 14-22 months compared to 7-11 months for those receiving chemotherapy only. However, response rates are quite low as the three most commonly used immunotherapy agents—pembrolizumab, nivolumab, and atezolizumab—have response rates of 41%, 19%, and 15% respectively. It is necessary to gain a better understanding of which characteristics are best associated with positive responses to immunotherapy.

METHODS: Data on receipt of immunotherapy, overall survival, age, sex, race, histology, marital status, and Charlson comorbidity scores were extracted from SEER, a Medicare linked dataset. Patients with a microscopically confirmed Stage IV NSCLC, and for whom lung cancer was their first or only primary cancer were screened for inclusion. All analyses compared patients receiving chemotherapyimmunotherapy combination to those receiving chemotherapy only. Age, sex, race, histology, marital status, and Charlson comorbidity scores were used as covariates in multivariable analyses of factors associated with receipt of immunotherapy (logistic regression) as well as factors associated with overall survival (Cox Proportional Hazards Model). Interaction terms were also included to quantify differences in effectiveness of immunotherapy along personal and clinical covariates. Propensity score matching (PSM) was used as a robustness check for statistically significant covariates.

RESULTS: Multivariate analyses of the stratified patient subgroups (n=765 males, n=657 females) showed that males’ OS increased with chemoimmunotherapy, but females’ OS did not significantly improve (HR male: 0.62 [0.51,0.75]; HR female: 0.81 [0.65,1.01]). The interaction between sex and immunotherapy effectiveness was borderline significant (p interaction-multivariable_sex = 0.056). PSM matching showed a consistent survival benefit with immunotherapy (HRPSM: 0.72 (0.60-0.85), and there was a significant interaction between sex and immunotherapy effectiveness (p interaction-PSM = 0.041).

CONCLUSIONS: Chemoimmunotherapy yields greater OS increases over chemotherapy for males than females, but there is less evidence for disparities in immunotherapy response across other personal characteristics.

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ABSTRACT 90 ADDED RISK FOR ALZHEIMER'S DISEASE? INVESTIGATING ALTERNATIVE SPLICING FROM A NOVEL DELETION IN NEUREXIN-1.

Adriana Pero1, Michael Fernando2, Kristen Brennand2. 1Medical Education, 2 Neuroscience. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. Alzheimer’s disease (AD) is the most common form of dementia. Although some medications can manage symptoms of AD, no drug can stop disease progression, with no clear understanding of many of the biomolecular processes underlying AD. Evidence suggests Neurexin (NRXN), pre-synaptic cell adhesion molecules, are important for cell-type specific synapse formation and may be implicated in the pathogenesis of AD. NRXN is highly spliced creating hundreds of isoforms capable of making unique protein interactions. A novel deletion in the NRXN1 cis-regulatome has been identified in 7 out of 258 cases of patients with Alzheimer’s disease using tissue samples from the Sinai brain bank. Recent evidence suggests many genetic variants related to AD affect RNA splicing. The deletion in NRXN1 may result in distinct alternative splicing events creating unique isoforms with added risk for AD. Identifying the isoform repertoire will lead to understanding cellular mechanisms resulting from the NRXN1 cis-regulatome deletion. Cortical tissue will be isolated from the 7 patients with the NRXN1 cis-regulatome deletion, 7 age, sex, and clinical-severity matched AD cases without deletions near NRXN1, and 7 age and sex matched controls. The first step of identifying NRXN1 isoforms was to validate and optimize a reliable protocol for isolating RNA from post-mortem brain tissue to use for long-read (SMRTseq). The protocol will allow for investigation of the NRXN1 isoform repertoire in postmortem brain tissue of AD patients with NRXN1 cis-regulatome deletion will illuminate how the deletion can affect the pathogenesis of AD, as well as add to a greater understanding of the overall role of NRXN in AD. The protocol will also provide a baseline for other endeavors to identify isoforms in the future using RNA from post-mortem brain tissue.

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ABSTRACT 91 EVALUATING THE OUTCOMES OF A PSYCHIATRY IN THE CREATIVE ARTS COURSE. Charlotte Pierce1, Timothy Rice2, Jacob Appel2. 1Medical Education, 2Psychiatry.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: The creative arts (including film, literature, poetry, painting, theatre, etc.) have historically been used to express the core of the human psyche and nature of human experiences. Incorporating the arts into medical education is increasingly prevalent and has been shown to enhance clinical and professional development not afforded by the pre-clinical education alone (Neha et al., 2019). Specifically, engaging medical students in creative work can help reduce stress, enhance peer interactions, promote reflection, resilience, and well-being (Katz et al., 2014; Perry et al., 2011). Moreover, it can improve medical students' respect, empathy, and interpersonal communication with patients (Charon, 2008). This six-week, seminarstyle course aims to engage students in narratives within film, the visual arts and literature in order to enhance students’ interpretive, relational and reflective capacities. To investigate the efficacy of this course’s impact on student empathy, well-being, and resilience, surveys will be conducted and analyzed pre and post course.

OBJECTIVE: To investigate the effects of a Psychiatry and Creative Arts Nexus Course on medical student empathy, well-being, and resilience.

METHODS: Participants will take an anonymous survey before and after the six-week course asking questions about their thoughts on psychiatry, thoughts on creative arts role in medical education, and their thoughts on the role of creative arts in their own well-being. The Connor Davidson Resilience Scale, Groningen Reflection Ability Scale, and Jefferson Scale of Empathy will also be included in the surveys to assess student resilience, well-being and empathy. The anonymous data will be analyzed in aggregate and compared to a control group (graduate medical, health, and science students not taking the course). We expect to enroll about 5 to10 medical students and no more than 5 MPH/MS students.

PRELIMINARY/EXPECTED RESULTS: Preliminary results are not available as post course surveys will not be administered until 11/20/21. We expect to see student’s improvement in wellbeing, empathy, and enhanced support for the utility of arts in medical education.

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ABSTRACT 92 EVALUATING RESOURCE UTILIZATION FOR IN-PERSON AND VIRTUAL JOINT CLASSES IN TOTAL JOINT ARTHROPLASTY: AN ANALYSIS OF ATTENDANCE PATTERNS AT A LARGE METROPOLITAN HEALTH SYSTEM. Nicholas Pitaro1, Joseph Barbera2, William Ranson2, Nicole Zubizarreta2, Darwin Chen2, Calin Moucha2, Brett Hayden2, Jashvant Poeran2. 1Medical Education, 2Orthopaedics.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Preoperative education via joint class is the standard of care in total joint arthroplasty (TJA).

Currently, data is lacking on joint class attendance patterns and how this may impact potential inequities in care. Moreover, it is unclear to what extent the recent shift towards virtual classes (due to COVID-19) has impacted attendance patterns.

OBJECTIVE: To identify patterns in pre-pandemic in-person joint class attendance and to understand the impact of virtual classes.

METHODS: A retrospective cohort study was conducted of 3,090 TJA patients exposed to three separately run joint classes. The primary outcome was joint class attendance and patient factors such as demographic, comorbidity, and functional status were variables of interest. Attendance was assessed pre-pandemic and again after the resumption of elective surgeries when classes transitioned to a virtual format. Univariable associations were assessed using standardized differences (SD), instead of p values, as univariable group differences easily reach statistical significance in large sample sizes. SD> 0.1 indicates statistical significance.

A multivariable mixed-effect model measured associations between demographics and class attendance.

RESULTS: The in-person and virtual attendance rates were 69.9% and 69.2%, respectively. In the prepandemic period, attendance rates were specifically higher for non-white (73.6%) vs. white patients (65.9%, SD=0.18), Hispanic (78.4%) vs. non-Hispanic patients (66.7, SD=0.26), those with non-English (80.1%) vs.

English (68.6%, SD=0.18) as primary language, and patients on Medicaid (85.9%), and Medicare (70.7%) vs. private insurance (62.6%, SD=0.32). We did not observe a change in the demographic distribution of attendees for virtual classes. Of note, age was a determinant of attendance for virtual (SD=0.11) but not inperson (SD=0.04). Contrastingly, physical distance from hospital was significant for in-person (SD=0.14) but not virtual (SD=0.06). On multivariate analysis of the full cohort, distance from hospital (p<0.05) and virtual (p<0.0001) were independent predictors of failed attendance.

CONCLUSION: This work highlights the relative importance of joint classes in specific patient subgroups.

While a virtual format was predictive of failed attendance, virtual class alleviated barriers to access related to physical distance but increased barriers for older patients. These results can guide providers on preoperative education and implementation of telehealth.

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ABSTRACT 93 ALTERED MICROGLIAL GENOME STRUCTURE AND TRANSCRIPTION IN HIV ENCEPHALITIS IMPACT HIV INTEGRATION. Amara Plaza-Jennings1, Brandon Pratt2, Benjamin Chen3, Lotje de Witte4, Susan Morgello5, Hyejung Won2, Schahram Akbarian4. 1Medical Education, 2Neuroscience, 3Medicine, 4Psychiatry, 5 Neurology. 1,3,4,5Icahn School of Medicine at Mount Sinai, New York, NY, 2 University of North Carolina School of Medicine, Chapel Hill, NC. BACKGROUND: HIV infection of microglia can lead to HIV associated neurocognitive disorder (HAND) and contributes to the formation of a potentially large viral reservoir, but the mechanisms of these processes remain poorly understood. Patients undergo an initial viremia prior to starting antiretroviral therapy, thus it is important to understand how active viral replication contributes to HAND and reservoir seeding. In CD4+ T-cells there is evidence for a vicious cycle model of HIV infection, whereby infection causes activation of T-cells, which is associated with broad changes to 3D-genome architecture and gene expression that in turn enhance HIV integration and replication. However, it is not known if the same is true in microglia.

OBJECTIVE: To determine whether active viral replication in the setting of HIV encephalitis (HIVE) is associated with changes to 3D-genome structure and transcription in microglia that may impact infection and brain function.

METHODS: All studied used postmortem frontal cortex tissue from the Manhattan HIV Brain Bank. Bulk nuclei were submitted for 10X Chromium single nucleus RNA-sequencing (snRNA-seq; n=2 HIV-, n=3 HIV+ without HIVE [HIV+], and n=3 HIV+ with HIVE [HIVE]). In situ Hi-C was performed on fixed microglial nuclei sorted using fluorescence activated nuclei sorting (FANS; n=2 HIV-, n=2 HIVE). Integration site analysis was performed on FANS isolated neuronal and non-neuronal nuclei for a total of 27 samples (n= 6 HIV-, n= 15 HIV+, n= 6 HIVE).

RESULTS: HIVE microglia underwent 3D restructuring of >6% of the genome. Regions that switched to a more open conformation contained genes relating to the immune response and had significantly higher expression in HIVE microglia by snRNA-seq. HIVE microglia overall showed increased expression of microglial activation and immune markers, driven by a subset of microglia with active HIV transcription.

Viral integration sites were found in highly expressed microglia genes and >75% were in regions of open chromatin defined by Hi-C. Furthermore, integration sites were enriched in regions that underwent changes in transcription, chromatin compartment, and cis-chromosomal 3D contacts.

CONCLUSIONS: These findings link HIVE to changes in microglial gene expression and spatial genome organization that influence viral integration, providing important insights as to how HIV infection impacts microglial function and contributes to disease development and viral persistence.

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ABSTRACT 94 TRUST BUT VERIFY: DISCORDANCE IN OPIOID REPORTING BETWEEN THE ELECTRONIC MEDICAL RECORD AND A STATEWIDE DATABASE. Amit Pujari1, David Forsh2. 1Medical Education, 2Orthopaedics.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: The Electronic Medical Record (EMR) is often used as the primary source for patient medication lists and history.

OBJECTIVE: To determine the accuracy of the EMR in documenting opioid prescriptions in patients undergoing fracture repair compared to a statewide database.

METHODS: This retrospective study was conducted at a level 1 trauma center. Patients undergoing fracture repair were identified using administrative records. Patients > 18 years old were included if they were admitted directly through the emergency room with isolated single orthopaedic injuries. Opioid-use and prescription-data prior to admission and 3-months following surgery was collected through the EMR and the Controlled Substance Utilization Review and Evaluation System (CURES), a database of controlled substance prescriptions in California. A 2x2 McNemar’s test to identify discordance, defined as only one source reporting an active prescription, between the EMR and CURES was used.

RESULTS: A total of 369 patients were included. The EMR reported that 143 patients had an opioid prescription within 30 days prior-to-admission, compared to 75 patients reported by CURES (discordance rate (DR): 34.7%) (p<0.001). Between postoperative days (POD) 0-30, the EMR reported that 367 (99.5%) of patients had an opioid prescription, compared to 285 (77.2%) reported by CURES (DR: 22.8%) (p<0.001).

Between POD 30-60, the EMR reported that 142 (38.5%) of patients had an opioid prescription, compared to 84 (22.8%) reported by CURES (DR: 34.7%) (p<0.001). Between POD 60-90, the EMR reported that 83 (22.5%) of patients had an active opioid prescription, compared to 60 (16.3%) patients reported by CURES (DR: 41.0%) (p = 0.10).

CONCLUSION: There is significant discordance between the EMR and a statewide database in documenting opioid use. Physicians should check multiple sources to best assess active opioid prescriptions.

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ABSTRACT 95 LONGITUDINAL FUNCTIONAL MRI DEMONSTRATES TRANSLOCATION OF LANGUAGE FUNCTION IN PATIENTS WITH BRAIN TUMORS. Addison Quinones1, Mehrnaz Jenabi2, Luca Pasquini2, Kyung Peck3, Nelson Moss4, Cameron Brennan4, Viviane Tabar4, Andrei Holodny2. 1Medical Education, 2Radiology, 4Neurosurgery. 1Icahn School of Medicine at Mount Sinai, New York, NY, 2,3,4Memorial Sloan Kettering Cancer Center New York, NY. BACKGROUND: Functional MR imaging’s (fMRI) ability to localize patient-specific eloquent areas has proved worthwhile in efforts to maximize surgical resection while minimizing risk of iatrogenic damage in patients with brain tumors. Cortical reorganization has been described but the frequency of occurrence and factors affecting incidence are less understood.

OBJECTIVE: We investigated changes in language laterality between two fMRI studies in brain tumor patients to elucidate factors contributing to cortical reorganization.

METHODS: We analyzed 37 patients with brain tumors involving language areas who underwent 2 separate pre-surgical, phonemic-fluency, task-based fMRI exams (fMRI1&2). Pathology consisted of LGG=15, HGG=18, Metastases=4. Time interval between scans averaged 35 months. Regions of interest were drawn for Broca’s Area (BA) and BA homologue. Laterality index (LI) was calculated where >0.2=left dominance, 0.2 to –0.2=co-dominance, and <-0.2=right dominance. Translocation of language function was defined as a shift across one of these thresholds between the two scans. Comparisons were performed using MannWhitney U-test between the two groups: translocation of language function (reorganized group) versus no translocation (constant group).

RESULTS: Nine patients demonstrated translocation of language function. Eight of nine patients with translocation had tumor involvement of BA, compared to 5 out of 28 patients without translocation (p<0.0001, Mann-Whitney U test). There was no difference in LI between the two groups at fMRI1. However, the reorganized group showed a decreased LI at fMRI2 compared to the constant group (-0.1 vs 0.52,p<0.01).

Within each group, the reorganized cohort showed a significant difference between LI1 and LI2 (0.50 vs –0.1,p<0.0001) while the constant cohort did not. A longer time interval was found in the reorganized group between fMRI1&2 for patients with LGG (34 vs 107 months,p<0.002). Aphasia was present following fMRI2 and subsequent treatment in 15/28 patients who did not show the translocation, compared to 2/9 patients who showed the translocation.

CONCLUSION: Translocation of language function in brain tumor patients is associated with tumor involvement of BA, longer time intervals between scans, and both LGG and HGG pathology. Translocation was associated with a decreased likelihood of post-treatment aphasia. Longitudinal fMRI is useful because it may indicate reorganization and could affect therapeutic planning for patients.

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ABSTRACT 96 INVESTIGATING PCDH7-EFNB3 INTERACTION IN HEPATIC STELLATE CELLS. Vignesh Rajasekaran1, James Carter2, Scott Friedman2. 1Medical Education, 2Medicine.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Hepatic stellate cells (HSCs) are the principal source of fibrogenic myofibroblasts in the liver and critical regulators of the response to liver injury. Protocadherin 7 (PCDH7) was identified as a novel HSC-specific surface receptor in a screen of HSC gene expression. PCDH7 knockout markedly attenuates HSC contractility in cell culture, but the signaling mechanism has not been established. PCDH7 protein interaction partners were surveyed using the mammalian-membrane two-hybrid assay (MaMTH) and Ephrin B3 (EFNB3), a member of the Ephrin family of receptor tyrosine kinases, was prioritized as a leading candidate interactor.

OBJECTIVE: To validate and characterize PCDH7-Ephrin signaling interactions. We also sought to characterize the expression of ephrins in a mouse model of liver fibrosis due to non-alcoholic steatohepatitis (NASH), developed in our lab.

METHODS: Using a human HSC cell line, LX2, we first confirmed the expression of Ephrin-B3 protein using western blot (WB). PCDH7 protein interactions were assessed by Co-Immunoprecipitation (CoIP) and WB. For CoIP, LX2 cells were transfected with a PCDH7-Flag expression construct and lysates were probed with an anti-Flag antibody. Ephrin expression was also evaluated by single nuclear RNA sequencing (snRNAseq) in a murine model of NASH and confirmed by qPCR. RESULTS: EFNB3 expression by HSCs was confirmed in snRNAseq datasets and by WB of protein lysates from LX2 cells. EFNB3 was not detected by Co-IP with PCDH7; however, a positive control is needed to confirm technical success of the IP. In the murine NASH model, snRNAseq confirmed that activated HSCs had greater and broader expression of ephrin subtypes than quiescent HSCs. Here, qPCR also showed that both type A and type B class ephrins were upregulated in NASH, with the greatest increase in EPHA3 (n=3, p=0.02) likely due to expansion of the HSC pool.

IMPLICATIONS: Ephrins were highly and specifically upregulated in HSCs in a NASH model. However, we could not confirm a PCDH7-EFNB3 interaction with initial CoIP studies; protein phosphatase 2A was identified as a suitable positive control for the next CoIP. Given their high and cell-specific expression in HSCs, ephrins may merit exploration as therapeutic targets to attenuate fibrogenesis by this cell type.

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ABSTRACT 97 ASSESSING NYC MEDICAL STUDENTS REACTIONS' DURING INITIAL SIX MONTHS OF COVID 19 PANDEMIC: A QUALITATIVE STUDY. Ezequiel Ramos1, Josimar Hernandez Antonio1, Jordyn Feingold2, Vedika Kumar3, Emma Stanislawski4, Alicia Hurtado2, Ksenia Gorbenko5. 1Medical Education, 2,3,4Psychiatry, 5Population Health Science and Policy.

1,2,5 Icahn School of Medicine at Mount Sinai, New York, NY, 3Zucker Hillside Hospital, New York, NY, 4 Maine Medical Center, Portland, ME. BACKGROUND: The unfolding of every major facet of life in the wake of the COVID-19 pandemic during spring 2020 has greatly affected medical education. Students were removed from school and the hospital, shifting to online learning. Many signed up to volunteer to assist NYC’s increasingly overburdened health system. Little is known about the personal impact the pandemic had on medical students living in NYC, once considered the epicenter of the pandemic in the US. In this exploratory study, we aim to investigate the impact with a holistic inventory of mental health & emotional responses of students at the Icahn School of Medicine at Mount Sinai.

OBJECTIVE: To determine reactions and factors contributing to medical student mental health. We anticipate that medical students will express increased negative emotions and empathic responses to these factors.

METHODS: We conducted forty semi-structured telephone interviews from August-September 2020 across students from all years and systematically analyzed the findings using ‘in vivo’ qualitative research methodology with Dedoose. Transcripts were recorded, individually coded and compared using an iteratively generated universal codebook. They were analyzed for emerging themes and patterns using a similar consensual process.

RESULTS: We grouped our findings into themes with the most salient being: ‘Uncertainty/Worry’ (‘I'm worried because it will have a pretty long standing impact on what practicing medicine looks like within the next several years), ‘Isolation’ (‘I think it mitigates the isolation but when you hang up [the phone] you're still, you know alone in your room’), ‘Anger’ (‘it certainly brings to life the holes in our system when the most vulnerable are not able to get the care they need... it renews my frustration with the medical system’), ‘Fear’ ('It was something I was consciously thinking about and would tell my parents, be careful when you go get groceries, you know there's a lot of violence against Asians right now’), ‘Something I had to get used to’ ('I just, you know, accepted that this is the reality and it is what it is’).

CONCLUSION: Given the pandemic's effects on mental health, understanding how medical students’ reactions and responses are key. These themes give valuable insight that reinforces the relevance of assessing medical students’ mental health in the long run and the importance of institutional support during the pandemic.

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ABSTRACT 98 PRIMARY SPOKEN LANGUAGE AND VARIANCES IN USE OF REGIONAL ANESTHESIA IN TOTAL JOINT ARTHROPLASTY FOR OLDER ADULTS. Hayley Raymond1, Husni Alasadi1, Nicole Zubizarreta2, Samuel DeMaria3, Calin Moucha2, Jashvant Poeran2. 1Medical Education, 2Orthopaedics, 3 Anesthesiology. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: As the population ages and becomes more diverse, it is crucial to investigate disparities in total joint arthroplasty (TJA) care for older adults. Non-White patients and those with non-commercial insurance undergoing total joint arthroplasty (TJA) surgery have lower odds of receiving neuraxial anesthesia, increasingly viewed as the standard of TJA care. Of additional concern is primary spoken language, as preoperative patient-anesthesiologist discussions on anesthetic options may be impaired by language barriers.

OBJECTIVE: To study disparities in receipt of neuraxial anesthesia, focusing on the role of primary spoken language, among TJA patients in a hospital system with a diverse patient population.

METHODS: This IRB-approved retrospective study included institutional data on 4,539 TJAs (2018-2019).

The primary outcome was neuraxial anesthesia use. Main variables of interest were primary spoken language (English, non-English), race (White, Black, Asian, Other), ethnicity (Hispanic, non-Hispanic), and insurance type (Commercial, Medicare, Medicaid, Other). Regression models measured the adjusted association between these variables and receipt of neuraxial anesthesia, focusing on primary spoken language as a potential explanatory variable. We report odds ratios (OR) and 95% confidence intervals (CI).

RESULTS: Neuraxial anesthesia was used in 84.7% (n=3,843) of TJAs; this was particularly lower in Medicaid (78.9%) patients while smaller differences were observed when looking at Black (82.1%) and Hispanic (87.1%) patients; all p<0.001. We did not find a significant unadjusted difference in neuraxial anesthesia use in patients with English (versus other languages) as primary language: 84.8% versus 84.7%, p= 0.271. In multivariable analysis, lower odds of receiving neuraxial anesthesia were specifically observed for Medicaid (OR 0.59 CI 0.45-0.78) and Medicare (OR 0.77 CI 0.61-0.96) patients, as well as those that do not have English as their primary language (OR 0.75 CI 0.58-0.98), all p<0.05.

CONCLUSION: Primary spoken language does appear to explain some of the existing disparities in receipt of neuraxial anesthesia in TJA patients. Given the negative impacts of these existing disparities, future studies are needed to further elucidate underlying mechanisms.

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ABSTRACT 99 LONG TERM NEUROLOGICAL IMPAIRMENTS OF MILD AND LONG HAUL COVID-19 INFECTION IMPEDE ACTIVITIES OF DAILY LIVING AND MENTAL HEALTH: USING NARRATIVE MEDICINE TO UNDERSTAND COVID-19 FROM THE PATIENT PERSPECTIVE. Emma Reford1, Nicki Mohammadi2, Natalia Romano Spica2, Christopher Kellner2.

1 Medical Education, 2Neurosurgery. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Post Covid-19 infection neurological impairments have been shown to be potential long term effects of the disease. Using Narrative Medicine research protocols to focus on the individual experience of illness, we emphasize the patient perspective in neurological outcomes of mild/short-term and/or long-haul Covid-19 infection and discuss their debilitating effects on activities of daily living and mental health.

METHODS: 46 Patients in a COVID-19 Remote Patient Monitoring Program (Precision Recovery: Mount Sinai Health System) were interviewed regarding their experience. Patients had been remotely and asynchronously monitored by a variety of specialists during their illness via RedCap data entry and telehealth visits. The interviews were conducted according to Narrative Medicine protocols and questions were developed in conjunction with a specialist in the field. Deidentified transcripts were coded in NVivo12 and were analyzed for qualitative significance.

RESULTS: Three key post-acute infection neurological impairments were identified: cognitive impairment, extreme fatigue, and dysautonomia. 20/46 (43%) of patients reported cognitive impairment after the acute phase of their covid illness, namely deficits in memory, attention, and stamina. 8/20 of these individuals (40%) were self-identified long-haul covid patients. 34/46 patients (74%) reported extreme fatigue as a symptom of their COVID-19 infection with 16/34 patients (47%) as self-reported long haul COVID-19 patients.

Dysautonomia was also reported in long haul patients, specifically the following symptoms: fluctuating fevers 12/18 (67%); heart palpitations/tachycardia: 12/18 (67%); digestion problems 8/18 (44%); dizziness 6/18 (33%); and fluctuations in blood pressure 4/18 (22%). 7/18 (39%) of patients reported 3 or more dysautonmic symptoms. Across all three neurological impairments, the main effects on daily living were: (1) inability to care for self (nutrition, hygiene, activity intolerance); (2) inability to care for others; and (3) employment alteration.

The main mental health effects were: (1) suicide ideation/attempt; (2) social isolation; and (3) anxiety and selfdoubt.

CONCLUSION: Across the spectrum of morbidity, post Covid-19 acute infection neurological impairment impaired activities of daily living and mental health. This is imperative to acknowledge for the development of clinical and social interventional protocol, support, and validation of affected individuals.

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ABSTRACT 100 ENABLING MORE INCLUSIVE HEALTHCARE: FOUR MARKET APPROACHES TO LGBTQ+ DIGITAL HEALTH. Jen Ren1, Adriana Krasniansky2, Ann-Gel Palermo1. 1Medical Education.

1 Icahn School of Medicine at Mount Sinai, New York, NY, 2Rock Health.

LGBTQ+ Americans face more discrimination in health settings and have lower-quality healthcare compared to non-LGBTQ+ Americans. We sought to answer the question: how can digital health support the health needs of LGBTQ+ patients to alleviate health disparities and discrimination that LGBTQ+ patients face? To do so, we combed through the existing Rock Health database of venture-funded digital health companies to identify those that either: 1) expanded their product or service offerings to better address the needs of LGBTQ+ individuals (“LGBTQ+-minded”) or 2) consider their core users as LGBTQ+ individuals (“LGBTQ+specific”). Using this typography, we segmented the market by 4 kinds of approaches. We created a map of the LGBTQ+ US digital health market, stratified the market on a spectrum of “LGBTQ+-minded” to “LGBTQ+specific”, and identified 4 main market approaches. These 4 approaches include: extended services for LGBTQ+ consumers, expanded health benefits for LGBTQ+ care, queer-competent care navigation, and virtual care clinics for LGBTQ+ needs. We also are the first to estimate the venture funding size in the LGBTQ+ digital health space. In 2020, we estimate that funding for LGBTQ+-specific players was $9.6M and grew to $39.0M in H1 2021. This suggests that this is a rapidly growing area, and we see that the newness of this category aligns with the fact that funding for LGBTQ+-specific startups has been limited to Seed and Series A rounds. We also lay out future opportunity areas for LGBTQ+ digital health innovation, such as: beyond specialty care, LGBTQ+ care across all age groups, queer-competent training and resources for health systems, LGBTQ+ health benefits beyond family building, and applying an intersectional lens. We also recognize limitations to digital health solutions in realizing equitable healthcare for LGBTQ+ patients.

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ABSTRACT 101 SURVEY-BASED STUDY TO UNDERSTAND HS PATIENT EXPERIENCES AND PERCEPTIONS ABOUT I&D PROCEDURES. Rishab Revankar1, Howa Yeung2, Heather Holahan3, Priyanka Vedak4, Franklin Blum3, Christopher Sayed3.

1 Medical Education, 2,3,4Dermatology. 1Icahn School of Medicine at Mount Sinai, New York, NY, 2Emory University School of Medicine, Atlanta, GA, 3UNC Chapel Hill School of Medicine, Chapel Hill, NC, 4 UNC Chapel Hill School of Medicine, Chapel Hill, NC. BACKGROUND: Incision and drainage (I&D) procedures are frequently used to manage acutely painful abscesses in patients with hidradenitis suppurativa (HS). While previous literature shows that I&D results in high recurrence rates, the benefits, drawbacks, and various approaches have not been well-characterized.

Similarly, patient perceptions about I&D procedures have not been well-characterized.

OBJECTIVE: To characterize patient perceptions and experiences with I&D procedures and to identify aspects of the procedure and the associated wound care that are linked to negative patient perceptions.

METHODS: We created an IRB-approved survey to better characterize experiences with I&D procedures in HS patients. Surveys were distributed in clinic at UNC Dermatology and online to HS support group moderators, who delegated surveys to eligible group members. No personally identifiable information was collected.

RESULTS: 165 participants with HS reported at least one I&D. Many patients found I&D to be helpful for improving symptoms but found the procedures very painful and highly dread future I&D. Lower levels of dread were associated with increased anesthesia numbing (R=0.30, p=0.0001), provider compassion (RR=0.19, p=0.0079) and less pain during incision (R=0.39, p<0.0001) and anesthesia (R=0.24, p=0.0035).

Higher levels of perceived benefit were correlated with increased anesthesia numbing (R=0.23, p=0.0029), provider compassion (R=0.27, p=0.001), and less pain during incision (R=0.22, p=0.0021) and anesthesia (R=0.16, p=0.05). On a scale of 0-10 with 10 being the most dreadful, patients with post-op bandage reported lower levels of dread in comparison to those with packing, drain, or no wound care (7.2 vs. 8.0 vs. 7.9 vs. 9.5, p=0.0248). Two-sided ANOVA tests were conducted to determine statistical significance.

CONCLUSIONS: Good anesthesia and incision practices along with provider compassion reduce levels of dread and increased perceived patient benefits of I&D.

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ABSTRACT 102 DEMOGRAPHIC CHARACTERISTICS OF ASYLUM-SEEKERS WHO ENTERED VIA THE US-MEXICO BORDER AND PRESENTED TO A NYC CENTER FOR SURVIVORS OF TORTURE. Jeanette Rios1, Dinali Fernando2, Ben McVane2. 1Medical Education, 2Emergency Medicine.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: The Libertas Center for Human Rights in New York City provides comprehensive care to survivors of torture, 90% of whom are asylum-seekers. The routes by which these asylum-seekers entered the United States were not previously well characterized, nor the potential implications of these routes.

OBJECTIVE: To identify Libertas clients who entered the United States by crossing the southern US-Mexico land border and identify any unique demographic features of this group compared to clients who had entered by other routes.

METHODS: We conducted a retrospective observational study utilizing a chart review of the Libertas Center database. 572 Libertas clients who completed an intake process between March 2010 and June 2021 were included in the study. Differences in country of origin, age, gender, sexual orientation, religion, and education level, were assessed between both groups of asylum-seekers by Fisher’s exact test using STATA. RESULTS: During the 11 year period, 142 Libertas clients (24%) entered the US via the US-Mexico border.

When comparing these 142 clients to clients who did not cross the border, we found statistically significant differences in region of origin, religion, and education level obtained in the country of origin. 50% of clients who crossed the US-Mexico border were from Central America compared to 7% of clients in the non-border entry cohort (p-value<0.0001). 65% of the clients who crossed the border were Christian compared to 38% of the non-border cohort (p-value<0.0001). 18% of clients who crossed the border completed college or higher in their country of origin, compared to 56% in the other group (p-value<0.0001). Additionally, a remarkable 29% of clients crossing the border came from as far as Europe, Asia or Africa.

CONCLUSION: Nearly a quarter of Libertas clients entered the US by crossing the US-Mexico land border, suggesting that asylum-seekers move well beyond border states after entering the US via this route. These findings highlight the importance of a policy framework to ensure adequate funding for torture treatment programs receiving these asylum-seekers in regions geographically distant from the US-Mexico border in order to provide these clients much needed health, legal and social services and address the compounded trauma of their journeys. Additionally, it underscores the need for an innovative referral network to connect these clients with programs across the country, upon US entry at the border.

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ABSTRACT 103 IMPROVING END OF LIFE FOR OLDER ADULTS WITH FUNCTIONAL DISABILITY. Lukas Ritzer1, Claire Ankuda2. 1Medical Education, 2Geriatrics and Palliative Medicine.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Functional disability (FD) is defined as needing help with daily self-care or mobility activities.

As the number of older adults in the U.S. rises, those living with age-related FD is also set to increase. If not adequately managed FD threatens well-being. Although research has shown that FD intensifies as end-of-life (EOL) nears, it is unknown how varying lengths of FD at EOL impact well-being.

RESEARCH QUESTIONS: 1) how are symptom burden and mood associated with length of FD at EOL and 2) what resources influenced symptom burden and mood considering varying lengths of FD at EOL? METHODS: This retrospective cohort study used data from the National Health and Aging Trends Study, a nationally representative cohort of older Americans, designated as sample persons (SPs) who were interviewed yearly. After the SP dies, a proxy is interviewed regarding the SP’s last month of life. Our main measure was the length of FD at EOL. This included SPs who had no FD at EOL and those with FD within the last 2, 2-6, or 6 or more months of life. Symptom burden and mood were secondary outcomes. Symptom burden measures included unmet spiritual need, being bothered by pain, and anxiety. Mood measures included depression, rarely feeling full of life, and giving up improving life.

RESULTS: A parabolic association was found between unmet spiritual need and length of FD. SPs with no FD reported the highest rate of unmet spiritual need (67.2%) while those with the shortest length of FD reported it least (46.3%). The difference in unmet spiritual need in those with no FD was partially explained by lower hospice use. Hospice was independently associated with less unmet spiritual need (OR 0.37, 95% CI 0.270.53). Anxiety was most prevalent in SPs with 6 or more months of FD (30.3%). SPs with FD within the last 2 months of life reported least anxiety (10.6%). Longest FD was associated with the highest prevalence of being bothered by pain (62.7%), giving up improving life (45.5%), depression (41.3%), and rarely feeling full of life (57%).

CONCLUSION: Higher symptom burden is associated with having no FD at EOL and FD for the last 6 or more months of life. Poorer mood is also associated with having FD for the last 6 or more months of life. Lastly, we see that hospice is a potential modifying factor for unmet spiritual need. Future directions include identifying other resources that improve well-being for SPs with FD at EOL.

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ABSTRACT 104 RACIAL DISPARITIES IN CAREGIVER SUPPORT AMONG ADULT CHILDREN CARING FOR AGING PARENTS. Harley Roberts1, Katherine Ornstein2, Evan Bollens-Lund2, Amy Kelley2. 1Medical Education, 2 Geriatrics and Palliative Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Adult children provide a large portion of caregiving and support for older adults, including direct care, care coordination, and financial support.

OBJECTIVE: To assess racial and ethnic group differences in caregiver support among adult children of aging parents.

METHODS: We conducted a retrospective study using survey responses from the Health and Retirement Study (HRS) between 2002 and 2018. The sample population (n=8,040) included decedents aged 65 and over with at least one living adult child at their time of death. Caregiver support was defined as providing financial support, providing help with basic or instrumental activities of daily living (ADLs or IADLs, respectively), or coresiding with the care recipient. Respondents self-identified as Hispanic, non-Hispanic White, or non-Hispanic Black. Respondents were further stratified by dementia and marital status.

RESULTS: Out of 8,040 respondents, only 17% of White respondents reported receiving financial support from adult children, compared to 24% of Hispanic and 29% of Black respondents. Only 21% of White respondents coresided with an adult child, compared to 44% of Hispanic and 38% of Black respondents.

Rates of financial support and coresidence remained significantly higher for Hispanic and Black respondents regardless of marital status (p<0.001). Among married respondents, 31% of Hispanic and 27% of Black respondents received ADL/IADL help from adult children compared to 15% of White respondents. Among unmarried respondents, 58% of Hispanic respondents received ADL/IADL help, compared to 48% of White and 47% of Black respondents. For all race and ethnicity groups, dementia status was associated with greater financial support and ADL/IADL help but not coresidence.

CONCLUSIONS: Compared to White older adults, Black and Hispanic older adults are more likely to receive care and financial support from their adult children. Even when a care recipient is married, Black and Hispanic adult children still maintain integral caregiving roles. The disparate intergenerational impact of caregiving on racial and ethnic groups must be further examined. Policies providing more robust support to family caregivers are needed to lessen the negative long term financial impacts on families.

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ABSTRACT 105 EFFECT OF SURGICAL RESECTION ON QUALITY OF LIFE IN PATIENTS WITH CARCINOID SYNDROME: A PROSPECTIVE ANALYSIS. Andrew Rosowicz1, James Johnson2, Laura Olson2, Venu Bangla2, Edward Wolin3, Michelle Kim3, Celia Divino2. 1Medical Education, 2Surgery, 3Medicine. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Carcinoid syndrome describes a group of symptoms most commonly caused by welldifferentiated neuroendocrine tumors of the midgut that metastasize to the liver. These tumors release several biologically active amines and peptides including serotonin, which causes most of the clinical features of carcinoid syndrome. Patients often experience diarrhea, flushing, cardiac symptoms, and cognitive impairment. Somatostatin analogs such as octreotide and lanreotide are first-line treatment for carcinoid syndrome; however, these drugs are not always effective and can have adverse side effects. Surgical resection is an alternative approach to improving patients’ quality of life that has not been comprehensively studied.

OBJECTIVE: To track changes in self-reported quality of life in patients who have undergone carcinoid tumor resection.

METHODS: We administered prospective, longitudinal quality of life assessments using the 12-item Short Form Survey (SF-12). A preoperative survey provided the baseline quality of life measurement, and two additional surveys at the 3-month and 6-month postoperative time points allowed us to track any changes in quality of life that patients experienced following carcinoid tumor resection. Composite physical (PCS) and mental (MCS) health scores were calculated based on patient responses and compared across time points.

Trends in these scores were analyzed using Wilcoxon signed rank-sum tests.

RESULTS: This study included 19 patients who underwent carcinoid tumor resections from January 2020 to February 2021. The median age at time of surgery was 58 y/o (46, 69 IQR), and females represented 52.6% of the group. The median baseline PCS was 51.5, which increased to 54.8 at the 3-month time point and then decreased slightly to 54.2 at the 6-month time point. Neither of these changes in PCS were statistically significant. The median baseline MCS was 51.7, which decreased to 51.1 at the 3-month time point and then increased to 55.9 at the 6-month time point. The increase in MCS from 51.7 to 55.9 at the 6-month time point was statistically significant (p=0.004).

CONCLUSION: Based on our current results, patients who undergo carcinoid tumor resection experience some improvement in quality of life by the 6-month postoperative time point, represented by the increase in median MCS. While the change in PCS was not statistically significant, we hope that surveying more patients will demonstrate an increase in this metric as well.

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ABSTRACT 106 LONGITUDINAL EVALUATION OF CARDIAC FUNCTION AND STRUCTURE IN APOE NULL AND C57BL/6J MICE AFTER GAMMA AND SPACE-TYPE RADIATION EXPOSURE. Nathaniel Saffran1, Agnieszka Brojakowska2, Kenneth Fish2, Virginia Gillespie2, Lahouaria Hadri2, David Goukassian2. 1Medical Education, 2Medicine. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. Space radiation (IR) from Solar Particle Events (SPE) and Galactic Cosmic Rays, also known as high charge and energy (HZE) ionizing IR, is a primary risk associated with deep-space missions. There are limited animal and human studies on the risk of cardiovascular disease (CVD) development due to space-IR. Our recent longitudinal studies showed Apolipoprotein-E (ApoE) null and C57BL6/J wild type (WT) male mice exhibit reduced global systolic function at 14 and 28 days after exposure to gamma (γ) and simplified GCR simulated (simGCRsim)-IR. No significant changes were observed between control and remaining IR groups up to 400 days post IR. At 22 months, both WT and ApoE null γ-IR male mice showed significant cardiac dysfunction paired with structural alterations. To assess for any sex effects following IR exposure, we hypothesized similar alterations in CV function in female ApoE and WT mice following the same IR exposure.

Three-month-old female age-matched WT and ApoE null mice were irradiated with 137Cs-γ -IR (100 cGy, 0.662 MeV) and simGCRsim (50 cGy, 500 MeV/n). Control ApoE null and WT mice were fed with mouse chow (normal diet-ND) and Western diet (WD) without irradiation. ApoE null mice are predisposed to atherosclerosis development when fed a WD due to impaired clearance of plasma LDL, while WT mice do not develop atherosclerosis. We assessed left ventricular (LV) function by transthoracic echocardiography at 14, 28, 365 days post-IR following the same cohort of mice for each treatment condition longitudinally.

At 28 days post IR, 50 cGy simGCRsim-IR ApoE null mice exhibit reduced LVEF and LVFS, which paired with decreased posterior wall thickness (LVPWd) may suggest an early acute effect of IR on systolic function. By 180- and 365-days post-IR, no alteration in LVEF or LVFS were observed in non-IR WD-fed mice and both IR groups of both genotypes. However, LV internal diameter (LVIDd), stroke volume (SV), and LV mass were reduced in 50 cGy simCRsim-IR mice at 365 days suggesting possible decompensation and altered diastolic function. In female ApoE null mice, there was no significant alteration in global LV systolic function across any treatment groups at 28-, 180-, and 365-days post IR. LV function will be measured at 1.5 and 2 years postinitial exposure. These findings do not exclude the possibility of increased acute or degenerative CVD risks at lower doses of space-type IR and/or when combined with other space travel-associated stressors.

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ABSTRACT 107 RE-EVALUATING THE NEED FOR ROUTINE PREOPERATIVE TYPE AND SCREEN IN ROBOTIC PROSTATECTOMIES. Jay Sanghvi1, Garrett Burnett2, James Maher2. 1Medical Education, 2 Anesthesiology. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Increasing healthcare costs, rising medical debt disproportionately affecting low-income communities and transition to value based care has called for re-evaluation of routine interventions that might not improve patient outcomes. Retrospective studies conducted on various surgical specialties have shown that routine type and screen (T&S) can reduce efficiency, increase expenditure without improving patient outcomes and conventional blood ordering protocols need to be critically evaluated to match evolution of surgical techniques.

Over the past decade, robotic surgical approach has continued to be adopted for a wide range of Urologic procedures. Reduction in blood loss has followed the advancements in operative technique but T&S is routinely ordered preoperatively due to historical bleeding concerns.

Traditionally physicians would determine which surgical procedures require blood ordering tests based mostly upon historical anecdotal experience. With the advent of EMRs and anesthesia information systems, we can adopt a more data driven approach. By retrospectively analyzing the blood loss and transfusion risk recorded in robotic prostatectomy/cystectomy patients, we hope to determine if robotic prostatectomy procedures is truly high risk for blood loss/transfusion to justify ordering routine T&S tests on all patients. We hope our data translates to changes in protocols and reduction in unnecessary costs.

METHODS: In this retrospective study, we reviewed a total of 2800 robotic radical prostatectomies patient records at Mount Sinai Hospital and Mount Sinai West from 01/2013 to 08/2019. We identified percentage (%) of patients transfused intraoperatively, estimated blood loss (EBL), transfusion index (mean # pRBCs transfused per patient), patients’ starting hematocrit and hemoglobin prior to surgery, # of antibody positive screens and % transfusion post-surgery during recovery.

PRELIMINARY RESULTS: Based on our preliminary chart review and data collection we found that the average EBL for robotic prostatectomy was 167mL, the percentage of patients transfused intraoperatively was 0.44 percent and only 0.70 percent of patients were antibody positive. We expect to demonstrate that blood transfusion, EBL and rate of antibody positive T&S's prostatectomy patients is low enough for clinicians to re-evaluate ordering routine T&S in this population. Future studies should be geared towards investigating whether T&S is cost effective.

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ABSTRACT 108 PRIMARY CARE ENGAGEMENT AND ASSOCIATED RISK FACTORS FOR PEOPLE WHO USE DRUGS AND/OR ALCOHOL. Remington Schneider1, Jeffrey Weiss2, Linda Wang3. 1Medical Education.

2,3 Medicine. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: A comprehensive approach to healthcare—one which includes primary care, stigma-free support, and removal of the barriers to the complexities of health systems—has been shown to be effective for the treatment of people who use drugs and/or alcohol.

OBJECTIVE: This study examines quality metrics in primary care for patients who use drugs and alcohol seen in the REACH Program.

METHODS: The study sample included 104 patients engaged in primary care for at least 6 months.

Outcomes included blood pressure (BP) control, colon cancer screening (CRC), breast cancer screening, and diabetes control (hemoglobin values, eye exams, and medical attention for nephropathy). Each quality measure was dichotomized into whether or not it met the corresponding benchmark. In addition, changes from baseline for BP and HbA1c values were examined at both 12 and 24 months, while changes from baseline for CRC screening, diabetes eye exams and nephropathy labs, were examined at 24 months. The predictors of primary care outcomes examined included sociodemographics, insurance, housing instability, medical and psychiatric comorbidities.

RESULTS: Quality metrics were met at baseline for 21/42 (50%) with hypertension, 22/69 (32%) for CRC screening, and 6/13 (46%) breast cancer screening. At baseline, 11/15 (73%) of diabetic patients had controlled HbA1c levels, 7/15 (47%) had recommended nephropathy labs, and 2/15 (13%) had recommended eye exams.

Among the uncontrolled BP patients at baseline, 12 patients met controlled values at 12 months while 4 did not.

Among patients who did not meet the CRC benchmark at baseline, 8 met them after 24 months, while 18 did not. For breast cancer screening, only one patient met the benchmark within 24 months after not meeting it at baseline. Only one person with uncontrolled HbA1c at baseline was controlled at 12 months. After 24 months, 2 patients without nephropathy labs and eye exams at baseline met recommendations. Across all outcomes, age and gender were not found to be significant predictors of any primary care baseline measures (all p > 0.05). While several medical and psychiatric predictors appear related to changes in outcomes over two years of engagement, small N values do not allow for statistical analysis.

CONCLUSIONS: Baseline levels and changes in primary care metrics differ across outcomes of interest in patients who use drugs and alcohol. Exploration of associations to changes over time warrant examination in larger data sets.

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ABSTRACT 109 THE IMPACT OF PRIOR ARTHROSCOPY ON OUTCOMES FOLLOWING UNICONDYLAR KNEE ARTHROPLASTY: A NATIONAL MEDICARE DATA ANALYSIS. Kush Shah1, Jashvant Poeran2, Hsin-Hui Huang2, Darwin Chen2, Brett Hayden2, Calin Moucha2.

1 Medical Education, 2Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Prior arthroscopy has been associated with various adverse outcomes after total knee arthroplasty, including infections, stiffness and all-cause revisions. Data is currently lacking on prior arthroscopy in unicondylar knee arthroplasty (UKA), a much smaller surgical cohort requiring the use of national data.

OBJECTIVE: Using national Medicare data, we sought to study the impact of prior knee arthroscopy on outcomes after subsequent UKA. METHODS: This IRB-approved retrospective cohort study included Medicare claims data on n=20,303 UKAs (Oct 2016-Sep 2018). Patients were divided into two cohorts: those with knee arthroscopy on the same knee within the two years prior to their UKA surgery and those without arthroscopy in the two years prior to their UKA (control group). Primary outcomes (1-year surgical complications rate, 90-day surgical complications rate, and 90-day readmissions costs) and secondary outcomes (90-day readmissions rate and 90-day outpatient costs) were compared between patients with and without prior arthroscopy. Regression models were subsequently utilized, for which we report odds ratios (OR; % change for continuous variables) and 95% confidence intervals (CI).

RESULTS: Among 20,303 included patients undergoing UKAs, 1,004 (4.9%) patients had a prior arthroscopy.

UKA patients with a prior arthroscopy (compared to those without) were somewhat younger (median age 71 versus 73 years, p<0.0001). On univariate analysis, there was no difference in 1-year complications (p=0.605), 90-day complications (p=0.636), and 1-year readmissions payments (p=0.137) between patients with and without prior arthroscopy. 90-day outpatient visit costs (p=0.117) and 90-day rates of readmission (p=0.17) were also comparable between the two groups. On multivariate analysis, patients with prior arthroscopy were found to have lower costs related to 90-day readmissions than patients without prior arthroscopy (-46.40%, 95% CI -68.76% - -8.04%, p=0.024).

CONCLUSION: Contrary to findings from the total knee arthroplasty literature, prior arthroscopy does not negatively impact surgical outcomes, readmissions, and costs after UKA. Some caution is warranted as this is a smaller surgical cohort than the total knee arthroplasty population and continued monitoring may be needed.

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ABSTRACT 110 BUPRENORPHINE TREATMENT DURING COVID-19 IN A HARM REDUCTION PRIMARY CARE SETTING. Jacob Sherman1, Remington Schneider1, Jeffrey Weiss3, Linda Wang4.

1 Medical Education, 3,4Medicine. 1,2,4Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Buprenorphine is an effective treatment for Opioid Use Disorder (OUD) and retention in buprenorphine treatment is associated with reduced overdose events and mortality. The COVID-19 pandemic created new challenges in accessing treatment. REACH at Mount Sinai is a harm reduction primary care clinic with a robust buprenorphine program. REACH made several operational changes to facilitate access to care during the pandemic. While factors associated with retention in buprenorphine have been studied, it remains unknown how buprenorphine treatment has been impacted by the COVID-19 pandemic.

RESEARCH QUESTION: What were the buprenorphine treatment outcomes during the COVID-19 pandemic for a cohort of patients engaged in buprenorphine treatment at the start of the pandemic?

METHODS: This was a descriptive study of a cohort of 29 REACH patients. Inclusion criteria was a diagnosis of OUD and engagement in buprenorphine treatment at the start of the pandemic. Chart review was conducted to examine patient demographics, outcomes, and prescribing information from March 13, 2020 - March 13, 2021. The main outcomes assessed were buprenorphine treatment engagement and buprenorphine treatment medication possession ratio (MPR). The cohort was subdivided into groups based on high (>.8) or low (<.8) MPR and high/low engagement. Differences between the groups were described. No statistical analyses were performed due to small sample size.

RESULTS: The study cohort included 25 men; 4 women. The median age was 55. 23/29 participants met criteria for high engagement and 21/29 had MPR > .8. The high adherence group looked almost identical to the high engagement group - 20/29 patients fell into both categories. This overlap suggests that MPR and engagement could be used as similar metrics in assessing buprenorphine treatment. By both metrics, this cohort had extremely favorable treatment retention compared to national averages.

On average, the low engagement/adherence group was older, had previously been engaged in buprenorphine treatment for fewer months, was more likely to have unstable housing, and had more ER and hospital visits during the study period. These trends could indicate that being older and lacking stable housing could have been a barrier to accessing buprenorphine treatment via telehealth during the pandemic.

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ABSTRACT 111 PREDICTION OF LIVER DISEASE OUTCOME USING MR ELASTOGRAPHY. Joo Yeon Shin1, Ghadi Abboud2, Paul Kennedy2, Bachir Taouli2.

1 Medical Education, 2Radiology. 1Icahn School of Medicine at Mount Sinai, New York, NY, 2 Translational and Molecular Imaging Institute, New York, NY. BACKGROUND: METAVIR scoring is used to determine the activity and severity of hepatic fibrosis based on liver biopsies. Along with liver biopsy and blood tests, magnetic resonance elastography (MRE) has been applied to assess the degree of liver fibrosis. The objective of our study is to use initial liver stiffness measured with 2D MRE and initial blood tests to predict the long-term liver disease outcome, correlating with imaging and laboratory workup at 12 and/or 24 months after MRE. We will be narrowing the focus of the study to F3-F4 patients, excluding patients with Child-Pugh C, in order to provide guidelines on the progression of the liver disease from the F3-F4 and suggest robust, repeatable, and nonredundant features that can be selected on 2D MRE to predict the outcome.

HYPOTHESIS: Long-term liver disease outcome, including HCC, decompensation, liver transplant, and death, can be independently predicted in F3-F4 patients using baseline liver stiffness measured with MRE. METHODS: We will retrospectively review the charts of 185 patients with chronic liver disease and histopathologically proven advanced fibrosis and cirrhosis, who underwent MRE within a year of liver biopsy/resection and at least one follow-up at 12 or 24 months after the initial evaluation. Patients with prior liver transplant or Child-Pugh C will be excluded from this study. The clinical variables of this study include demographics, etiology of liver disease, and presence of HCC at baseline. We will assess the role of demographics, etiology of liver disease, blood tests, liver volume, and liver stiffness in predicting outcomes including HCC occurrence, decompensation, GI bleeding, liver transplant, and death.

RESULTS: In 63 patients, 62% are male, and 38% are female. 50.8% of patients had 3 or more etiologies, and 47.6% had HCC at baseline. Diagnostic images from 185 patients were imported. Selected relevant slices of images were used to measure the liver stiffness using ImageJ. Inter-observer selected 39 patients to measure liver stiffness to validate those measurements.

FUTURE WORK: Liver size will be measured to identify what percent of the liver is stiff and how that affected the disease progression. Statistical analysis will consist of uni- and multivariable modeling for the prediction of outcomes. 2D MRE and laboratory parameters will be compared between patient groups based on ChildPugh scores and the presence or absence of HCC by Mann-Whitney tests.

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ABSTRACT 112 EVALUATION OF PROGRAM TO IMPLEMENT HIV PREP SERVICES FOR WOMEN AT GYNECOLOGIC SERVICES. Francesca Silvestri1, Natalie Alvarez2, Omara Afzal2, Mary Siobhan Dolan2, Antonio Urbina3, Andres Ramirez Zamudio2. 1Medical Education, 2Obstetrics, Gynecology, and Reproductive Science, 3 Medicine. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: HIV Pre-Exposure Prophylaxis (PrEP) is under-utilized among the female population.

OBGYN providers are uniquely positioned to prescribe PrEP. Previous studies have demonstrated limited PrEP awareness among women. Despite barriers to uptake, women have expressed desire to initiate PrEP if counseled by their providers. To fill this gap, PrEP training was provided to residents and faculty in an OBGYN residency program.

METHODS: PrEP services were rolled out in an OBGYN ambulatory clinic following a PrEP training program. A sexual risk questionnaire and qualitative interviews were administered to assess the program.

The questionnaire assessed for past 12-month, self and partner HIV sexual risk factors and self-sexual risk perception. The questionnaire was utilized as a metric for PrEP counseling. Qualitative interviews were conducted with participants who were counseled on PrEP to explore the provider encounter. Frequency tabulations were run to assess the results from the questionnaire.

RESULTS: 29 sexual risk screeners were completed. All identified as female, the average age was 36.8, 31.0% were African American, 41.4% were Latina, 17.2% were White, and 10.3% identified as Other. 65.5% reported condom-less vaginal sex in the past 12 months, 6.9% reported condom-less anal sex in the past 12 months. Among the participants, 10.3% had a history of a STI, 3.5% had been given PEP, 3.5% were worried about their risk of HIV or STIs, and 3.5% were counseled on PrEP by their provider. Of the partners who the participant’s had condom-less sex with, 13.8% had an unknown HIV status, 6.9% had a history of a STI, and 3.5% identified as MSM. CONCLUSIONS: These results demonstrate that a majority (65.5%) of women engaged in condom-less vaginal sex in the past 12 months and a sizeable percentage (13.4%) had engaged in condom-less sex with a partner with an unknown HIV status. Participants also reported self and partner history of STIs and PEP administration in the past 12 months. These are all notable HIV transmission risk factors and helps to identify a target population that would benefit from PrEP use. In the future, qualitative interviews will serve as a quality improvement mechanism to better inform the roll out of the program.

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ABSTRACT 113 ASSESSMENT OF TELEMEDICINE-ENHANCED COMMUNITY PARAMEDICINE INTERVENTION AT A LARGE ACADEMIC MEDICAL CENTER. Zay Smolar1, Kevin Munjal2. 1Medical Education, 2Emergency Medicine.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Older adults’ EMS encounters, emergency department (ED) visits, and admissions use significant resources and contribute to poor quality of life. Community paramedicine (CP) programs, through which paramedics respond to acute but nonemergent concerns to reduce admission, 30-day readmission, and healthcare spending, are increasingly used to address these challenges. Few studies evaluate the use of CPs with synchronous, virtual physician oversight.

OBJECTIVE: Our goal was to assess the utility of Tele-CP at reducing three and 30-day ED visits and to identify clinical and demographic factors predictive of transport, return ED visits, and admission following transport.

METHODS: This was a retrospective review of patients in a value-based population who took part in a telemedicine-enhanced CP (Tele-CP) program from January 2019-March 2021 at a large academic medical center. When called by a patient with an acute concern, a clinician could request a community paramedic to visit the patient within 60 minutes. After performing a thorough assessment, the paramedic uses telemedicine to consult with an ED physician. Multivariate and Pearson's Chi Square analysis will be used in SPSS Statistics.

RESULTS: There were 495 encounters with complete data available with a mean patient age of 78.3 years, 75.2% of whom were female, and 58.6% of whom were Medicare-insured. Encounters included 42% White and 20% African American patients. Twenty-one percent of patients listed a language other than English as primary. The most common chief complaints were dyspnea (21%), generalized weakness (8%), and chest pain (7%). There were 205 patient transports (41%), with no significant differences among clinical or demographic groups. Among non-transported patients, there were 28 (9.7%) ED visits within three days and 50 (17.2%) visits within 30 days. The rate of three-day ED visits among African American patients was higher (19.3%) compared to other groups (χ2=7.53, p=.02). Among CP-transported patients, 142 (69.2%) were admitted, with higher rates among those with dyspnea (88.4%) and generalized weakness (85.7%, χ2=15.96, p = .001).

CONCLUSIONS: Our study shows that among this population of high-risk older adults, a large portion (49%) were able to avoid transport, ED utilization, and hospitalization through the three days following their acute episode. There were differences in outcomes among demographic groups that require further exploration.

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ABSTRACT 114 PREDICTORS OF POSTPARTUM DEPRESSION AMONG HISPANIC WOMEN DURING THE COVID-19 PANDEMIC. Daniela Suarez-Rebling1, Anna Rommel2. 1Medical Education, 2Psychiatry.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: COVID-19 has been linked to heightened levels of psychosocial stress, depression and anxiety. Pregnancy and the postpartum period are times of increased vulnerability to anxiety and depression, which may be exacerbated by the stress arising from the pandemic, particularly in underserved populations.

Hispanic communities, including undocumented individuals without access to federal aid, have been disproportionately affected by the pandemic.

OBJECTIVE: To determine predictors of postpartum depression and anxiety among Hispanic women who were pregnant during the COVID-19 pandemic.

METHODS: Using the Edinburgh Postpartum Depression Scale (EPDS), we assessed postpartum depression and anxiety in 92 Hispanic women enrolled in the prospective pregnancy cohort ‘Generation C’, who delivered between April and October 2020 at the Mount Sinai Hospital. EPDS scores were collected from electronic medical records (EMRs) or surveys. COVID-19 infection was assessed using SARS-CoV-2 antibody status in maternal blood. Potential predictors included seropositivity, maternal age and race, zip code, gestational age, birthweight, child sex, neonatal intensive care unit (NICU) administration, Apgar score at 5 min, child mortality, lengths of hospital stay, parity, insurance type and pandemic stressors (comprising housing, employment, frontline work, financial worries, and feelings of personal safety). A linear regression model was run in R to predict EPDS scores among Hispanic participants.

RESULTS: The results of the regression suggest that the predictor variables explain a significant amount of the variance in EPDS scores (F17, 72 = 2.16, p-value: 0.013, R2 = 0.34, R2Adjusted = 0.18). The analysis showed that being white (β=3.88, t=2.21, p=0.030), birthweight (β=0.003, t=2.16, p=0.034), child mortality (β=13.69, t=3.38, p=0.001), and public health insurance (β=1.80, t=2.01, p=0.048) significantly predicted EPDS scores in Hispanic women.

DISCUSSION: Within our sample of Hispanic women, maternal postpartum depression and anxiety during the COVID-19 pandemic were predicted by the child’s health, as well as demographic and socioeconomic factors. Future research should investigate how immigration status and access to mental health services are related to perinatal maternal mental health and its predictors.

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ABSTRACT 115 COMPARING VNS AND RESECTIVE SURGERY OUTCOMES IN PATIENTS WITH CO-OCCURRING AUTISM AND EPILEPSY TO PATIENTS WITH EPILEPSY ALONE: A POPULATION-BASED STUDY. Varun Subramaniam1, Churl-Su Kwon2. 1Medical Education, 2Neurosurgery.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Autism and epilepsy commonly co-occur. Understanding trends in healthcare utilization and hospital outcomes in patients with autism and epilepsy can help optimize care. We compared hospital outcomes amongst patients undergoing VNS and resective/disconnective surgery with autism and epilepsy to those with epilepsy alone.

OBJECTIVE: To investigate if there is a significant difference in hospital outcomes amongst patients undergoing VNS, resective/disconnective surgery with autism and epilepsy to those with epilepsy alone.

METHODS: Elective admissions amongst patients with epilepsy alone and co-occurring autism and epilepsy were identified in the 2003-14 National Inpatient Sample (NIS). The NIS is the largest US all-payer nationally representative database and includes patients and hospital level variables. Two cohorts were examined: one patient with co-occurring epilepsy and autism was matched to three epilepsy patients without autism for age, sex and 1) VNS and 2) resective/disconnective surgery. Differences in discharge status, in-hospital mortality, mean length of stay (LOS), cost and surgical/medical complications were examined. Multinomial logistic regressions were performed to examine the outcomes of interest in persons with comorbid autism and epilepsy to persons with epilepsy alone.

RESULTS: The following cohorts were identified: 1) VNS-52 hospital admissions in persons with comorbid autism and epilepsy (mean age:12.79±1.03; 19.27% female) and 156 matched controls with epilepsy alone (mean age:12.84±0.71; 19.31% female); 2) resective/disconnective surgery-113 with comorbid autism and epilepsy (mean age:12.99±0.84; 24.55% female) and 339 matched controls with epilepsy alone (mean age:13.37±0.68; 23.86% female). Patients with autism and epilepsy who underwent VNS and resective/ disconnective surgery showed no differences in discharge status, in-hospital mortality, mean length of stay, mean cost of hospitalization and surgical/medical complications compared to patients with epilepsy alone.

CONCLUSION: We have shown the feasibility and safety of epilepsy VNS and resective surgery in those with ASD do not differ with those with epilepsy alone. Contrary to the prevalent concern that epilepsy surgery in patients with ASD may have limited utility, we have found that in-hospital outcomes do not differ from those with epilepsy alone.

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ABSTRACT 116 ANTI-TUMOR EFFECTS OF VERTEPORFIN AND PHOTODYNAMIC THERAPY IN COMBINATION WITH STANDARD OF CARE ON PATIENT-DERIVED GBM CELL LINES. Sweta Sudhir1, Maria Anastasiadou2, Constantinos Hadjipanayis2. 1Medical Education, 2 Neurosurgery. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Glioblastoma (GBM) is the most common and aggressive primary brain cancer with a median survival of approximately 15 months. GBM tumorigenicity frequently arises from aberrant receptor tyrosine kinase (RTK) pathways. Amplification of the Epidermal Growth Factor Receptor (EGFR) gene upregulates YAP1 and TAZ transcription factors of the Hippo pathway. This leads to tumor cell proliferation, radiation resistance, and poor survival for patients with GBM.Verteporfin (VP), also known as Visudyne, is an FDA-approved macular degeneration photodynamic therapy (PDT). VP is a small-molecule inhibitor of the YAP/TAZ/TEAD complex that has recently been shown to reduce tumor migration and is currently being studied in an early phase clinical trial as a chemotherapeutic for patients with recurrent GBM. OBJECTIVE: To understand if VP is an effective photosensitizer for PDT in GBM that can also enhance the effects of TMZ and RT. We hypothesize VP will sensitize cells to PDT and chemoradiation therapy by downregulating the Hippo pathway, increasing apoptosis, and inhibiting intravasation.

METHODS: We used four patient-derived GBM cell lines - two without EGFR expression and two with EGFR protein overexpression. Experimental conditions: Control, VP, VP+PDT, VP+PDT+TMZ, TMZ+RT (CRT), VP+PDT+TMZ+RT (combined therapy). Hypothesis tested using MTT, cytotoxicity, western blot, immunofluorescence (IF), and intravasation.

RESULTS: Compared to VP alone, VP+PDT reduced the IC50 of VP treatment in all GBM cells. Light activation of VP has a significant antitumor effect as observed with cytotoxicity in comparison to control cells and VP alone (p<0.01). Compared to control, VP, VP+PDT+TMZ, and CRT show significantly less intravasation (p<0.01). Furthermore, the combination of VP+PDT may reduce expression of YAP/TAZ/TEAD of the Hippo pathway via Western Blot analysis compared to control and VP alone. YAP signaling may be reduced by IF staining in GBM cells with overexpression of EGFR. CONCLUSIONS: Our research supports the use of VP as a photosensitizer in GBM cells. We found downregulation of the hippo pathway and decrease tumorigenicity of GBM cells. Utilization of this treatment alongside standard of care may prove beneficial in reducing recurrence of GBM. We plan to further explore these in vitro findings in mice models and investigate other pathways including immune response with NanoString analysis in the future.

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ABSTRACT 117 PSYCHOLOGICAL RESILIENCE IN FRONTLINE HEALTHCARE WORKERS DURING THE ACUTE PHASE OF THE COVID-19 PANDEMIC IN NEW YORK CITY. Shumayl Syed1, Robert Pietrzak2, Jordyn Feingold3, Adriana Feder3, Dennis Charney3, Lauren Peccoralo4, Steven Southwick2, Jonathan Ripp4. 1Medical Education, 2,3Psychiatry, 4Medicine. 1,3,4Icahn School of Medicine at Mount Sinai, New York, NY, 2Yale University, New Haven, CT. OBJECTIVE: While studies have begun documenting the psychological consequences of the COVID-19 pandemic in front-line healthcare workers (FHCWs) we aimed to examine which factors are associated with psychological resilience in FHCWs during the acute stage of the COVID-19 pandemic.

METHODS: Data were collected from a single urban tertiary care hospital in NYC between 4/14/2020 and 5/11/2020, during the peak and initial decline of the acute patient surge. An anonymous incentivized survey was e-mailed to a purposively-selected sample of 6,026 FHCWs. From this sample, 3,360 (55.8%) completed the survey, of whom 2,579 (76.8%) reported directly providing care for patients with COVID-19 and also had complete data. Occupational and personal COVID-19-related stressors, as well as resiliencepromoting factors, were assessed. Multiple regression and relative importance analyses were used to identify independent variables associated with psychological resilience scores and the variance in these scores that was attributable to each of these variables.

RESULTS: Relative importance analyses revealed that positive emotions (interested (relative variance explained [RVE]=14.7%), enthusiastic (RVE=11.2%)), self-efficacy (RVE=13.8%), non-engagement in substance use coping (RVE=9.9%), higher purpose in life (RVE=7.8%), emotional support (RVE=6.9%) and leadership support (RVE=6.8%) were most strongly associated with psychological resilience, collectively explaining >70% of the variance in these scores.

CONCLUSION: These results underscore the importance of multi-faceted resilience-promoting approaches focused both on individual-level initiatives, as well as broader organizational strategies aimed at bolstering communal and leadership support to optimize FHCW psychological resilience during times of crisis. Followup in this cohort is necessary to determine the sustainability of these resilience promoting factors and interventions are necessary to bolster the coping strategies that were found to be most helpful.

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ABSTRACT 118 SPINE VS. HAND SURGEONS: A SENTIMENT ANALYSIS DRIVEN COMPARISON STUDY OF ORTHOPEDIC SURGEON ONLINE REVIEWS. Justin Tang1, Varun Arvind1, Jun Kim2, Samuel Cho2. 1Medical Education, 2Orthopaedics.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Online websites that allow patients to write reviews on physicians are increasing in popularity and have immense influence on their provider selection. However, written reviews are subjective and difficult to analyze quantitatively. Sentiment analysis through natural language processing and machine learning provides the ability to quantitatively assess these written surgeon reviews in order provide actionable feedback to improve their practice.

OBJECTIVE: This study quantitatively analyzes the online written reviews of spine and hand surgeons utilizing sentiment analysis and report trends in words used to describe the best and worst reviewed surgeons.

Additionally, this study analyzes the relationship between demographic factors and sentiment analysis scores.

We hypothesize that gender will not be significantly related to scores but age will.

METHODS: Online written and star-rating reviews of spine surgeons were obtained from healthgrades.com.

The “Valence Aware Dictionary and sEntiment Reasoner” (VADER) package was used to obtain compound sentiment analysis scores of each review. T-tests were performed on demographic variables and average sentiment score of written reviews. Further, word and word-pair frequency analysis was performed to provide context to these words used to describe surgeons. Finally, a multiple logistic regression was performed on significant words to determine the odds of receiving positive reviews.

RESULTS: 786 hand and 480 spine surgeons were analyzed for a total of 15,995 reviews. There was no difference between genders and sentiment scores, but there was a significant difference in scores based on age in both cohorts (p<0.01). Word frequency analysis highlight pain and behavioral factors as main contributors to best/worst reviews. Logistic regression indicated that pain (OR=0.35,0.38; CI:0.300.42,0.33-0.43; p<0.01 for hand and spine, respectively) was a significant variable in negative reviews.

Trends in words were similar in both hand and spine surgeons.

CONCLUSIONS: Both cohorts had similar results in demographic analysis and the trends in words used to describe them. The best reviews emphasize pain management and bedside manner. However, the worst reviews primarily focus mainly on pain seen in the frequency and multivariate analysis. Pain is a clear contributing factor to reviews, thus emphasizing the importance of establishing proper pain expectations prior to any intervention.

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ABSTRACT 119 DETERMINING TRENDS IN PROCEDURE COST, TOTAL HEALTHCARE UTILIZATION, AND DIRECT PAYMENTS MADE BY PATIENTS FOR PRIMARY ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION BETWEEN 2013 AND 2017.

Justin Tiao1, Brennan Chu1, Alexis Colvin2. 1Medical Education, 2 Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Torn anterior cruciate ligaments (ACLs) are one of the most common orthopedic injuries in the U.S. with an incidence of ~100,000/year. Healthcare costs have also been rising for a long time and are expected to continue to rise at a rate higher than inflation. Thus, it is important to know the cost of performing an ACLR and how much cost the patient is expected to bear.

OBJECTIVE: To report on immediate procedure, total healthcare utilization (THU), and patient out-of-pocket cost for outpatient arthroscopically aided ACLR, identified by Current Procedural Terminology (CPT) code 29888 from the years 2013-2017.

METHODS: Patients who had undergone outpatient arthroscopic ACL reconstruction in the U.S. from 2013 to 2017 were identified using the IBM MarketScan Commercial Claims and Encounters Database. Continuously enrolled patients who had Current Procedural Terminology (CPT) code 29888 between April 1, 2013 and June 30, 2017 were included. Immediate procedure cost was calculated using a 3-day window around the day of surgery and THU was calculated using a 9 month perioperative period around the day of surgery, 3 months preoperatively to 6 months postoperatively, from claims with a “knee-related” diagnosis code. Patient outof-pocket cost was determined by the sum of the copay, coinsurance, and deductible. Descriptive statistics, median and interquartile range, were calculated for each cost variable. All cost variables were adjusted for inflation to 2017 dollars.

RESULTS: A cohort of 47,471 ACLR patients was identified. We found a decreasing trend in immediate procedure cost during the study period (rho = -0.031, p < 0.001), but an increasing trend in patient out-ofpocket cost (rho = 0.064, p <0.001). Immediate procedure cost in 2017 ($11,456) was 4.6% lower than in 2013 ($11,991), but patient out-of-pocket cost was 25.4% higher for the procedure ($1,500 in 2017 and $1,119 in 2013). THU costs also decreased (rho = -0.012, p = 0.012), but patient out-of-pocket cost for THU increased (rho = 0.074, p < 0.001). THU cost in 2017 ($16,599) was 3.3% lower than 2013 ($17,138), but patient cost was increased 15.9% ($2553 in 2017 and $2146 in 2013).

CONCLUSION: Healthcare costs related to the immediate procedure as well as THU have decreased slightly from 2013 to 2017, but patient out-of-pocket costs have increased significantly. This is significant because even though ACLR costs to the healthcare system have stagnated, the cost to patients is increasing.

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ABSTRACT 120 TWO-CENTER STUDY OF A VIRTUAL, SIMULATION-BASED LAPAROSCOPIC TRAINING CURRICULUM IN MEXICO. Rachel Todd1, Zerubabbel Asfaw2, Maria Marcela Bailez3, Jacqueline Narvaez4, Linda Zhang5.

1 Medical Education, 3,5Surgery. 1,2,5Icahn School of Medicine at Mount Sinai, New York, NY, 3JP Garrahan Pediatric Hospital, Buenos Aires, Argentina, 4Society of American Gastrointestinal and Endoscopic Surgeons Los Angeles, CA. Adult medical education is an area of interest in global health for expanding the surgical capacities of low and middle-income countries (LMICs), where the practice of laparoscopic surgery is rapidly expanding y et formal training in laparoscopy remains limited. In 2017, Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) implemented Global Laparoscopic Advancement Program (GLAP), an in-person simulation-based laparoscopic training curriculum for surgeons in LMICs. Due to the COVID-19 pandemic, GLAP was adapted to a 6-month virtual format. This study explores the feasibility and efficacy of virtual laparoscopic simulation training in two resource-limited settings in Mexico. Participants from Leon and Guadalajara, Mexico enrolled in the virtual GLAP curriculum, meeting biweekly for 2-hour didactic classes and hands-on simulation practice. Participants completed pre- and post-program surveys assessing their perception of simulation-based training. Surgical residents’ laparoscopic skills were evaluated using the Fundamental of Laparoscopic Surgery (FLS) exam during initial and final weeks of the program. Of the 26 total participants (10 attendings, 16 residents), 20 completed the post-program survey, while 13 residents submitted their results of both pre- and post- evaluation of FLS skills. At completion of the program, residents were 34.41% faster in completing the bimanual transfer (2:31 vs 4:27, p< 0.05), 31.82% faster on the precision cutting (4:05 vs 6:12, p<0.05), 109.21% faster on the endo-loop task (1:30 vs 2:47, p< 0.05), and 35.38% faster on the intracorporeal knot (5:39 vs 9:42, p<0.05). There was no significant difference in completing extracorporeal knot tie (4:52 vs. 6:59, p=0.115). On a Likert scale (1=worst, 5=best), participants appreciated the program’s quality (mean 4.7), effectiveness of teaching (mean 4.7), depth of content (mean 4.55), and quality of faculty (mean 4.9). Participants considered the practice sessions (50%) and friendly competition (20%) as their favorite aspects, while the theoretical sessions (15%) and scheduling (15%) were the least favorite aspects of the program. A virtual simulation-based curriculum can be an effective training strategy for teaching laparoscopic skills to surgeons in LMICs such as Mexico. Future programs can expand on the use of a virtual platform as a low-cost, effective strategy for training laparoscopic skills in other LMICs across the globe.

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ABSTRACT 121 ASSOCIATIONS BETWEEN PRENATAL PARTICULATE AIR POLLUTION AND INFANT LUNG FUNCTION. Serena Tolani1, Whitney Cowell2, Maritza Minchala3, Brent Coull4, Rosalind Wright3, Alison Lee2.

1 Medical Education, 2,3Pediatrics. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY, 4 Harvard T.H. Chan School of Public Health, Boston MA. BACKGROUND: Environmental programming of child lung function begins in utero. Prenatal ambient air pollution has been linked to impaired lung function in later childhood with some studies demonstrating sex-specific effects. The influence of fine particulate matter (PM2.5) exposure over gestation on infant lung function has not been examined.

OBJECTIVE: We aimed to examine time-varying associations between prenatal PM2.5 and infant lung function at age 6 months, as indexed by tidal breathing analyses and to explore sex-specific effects.

METHODS: We leveraged the prospective Programming of Intergenerational Stress Mechanisms (PRISM) cohort in the Northeastern United States. Daily maternal PM2.5 exposure levels over gestation were estimated based on residential addresses using a validated spatiotemporal model. Infant tidal breathing analyses were conducted in a laboratory setting using respiratory inductance plethysmography at age 6 months.

We performed multivariable Bayesian distributed lag interaction models (BDLIMs) to identify time-varying associations between prenatal PM2.5 exposure as a continuous variable and infant lung function with effect modification by child sex.

RESULTS: Analyses included 402 mother-child dyads enrolled at 27.2± 5.9 weeks gestation. Infants were 55% male (n=221), 38% Black/Black Hispanic (n=153), and 36% Hispanic non-Black (n= 145); 39.8% of mothers reported <12 years of education (n= 160). The mean daily PM2.5 exposure was 8.26± 4.31 μg/m3 over pregnancy. BDLIMs identified sensitive windows during gestation where infants exposed to higher prenatal PM2.5 had lower respiratory rate (sensitive windows at 14-18 weeks and 31-35 weeks gestation), higher total breath timing (sensitive windows at 30-35 weeks gestation), lower mean inspiratory flow (sensitive windows 23-24 weeks) and higher time to peak expiratory flow to total expiratory time (tPEF: TE, sensitive windows 1-3 weeks and 39 weeks).

BDLIMs did not identify effect modification by infant sex for any lung function parameter.

CONCLUSIONS: These analyses demonstrate that associations between maternal exposure to increased ambient fine particulate matter in pregnancy and altered lung function are evident in 6-month-old infants.

Identifying risk as early in development as possible is critical to intervene and optimize lung development as impaired early childhood lung function is linked to greater respiratory morbidity over life course.

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ABSTRACT 122 IN-HOSPITAL OUTCOMES IN PATIENTS WITH AND WITHOUT EPILEPSY DIAGNOSED WITH COVID-19.

Claire Ufongene1, Jung-Yi Lin2, Grace Van Hyfte2, Jonathan goldstein2, Brian Mathew2, Allison Navis2, Louise McCarthy2, Leah Blank2, Ariella Cohen2, Mandip dhamoonm2, Pojen deng2, Eveline gutzwiller2, Qing Hao2, Celestine He2, Wilson D. Heredia Nunez2, Britany Klenofsky2, Hernan Nicolas Lemus2, Lara Marcus2, Veronica Peschansky2, Anuradha Singh2, Gabriela Tantillo2, James Young2, Parul Agarwal2, Priti Balchandani2, Nathalie Jette2. 1Medical Education, 2Neurology. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. COVID-19 affects many organ systems. Neurological symptoms have been reported with COVID-19 but data is limited on outcomes in those with pre-existing neurological conditions, including epilepsy. We hypothesized that compared to patients without epilepsy, patients with COVID-19 and epilepsy would have worse outcomes despite adjustment for confounders. The aim of this study was to evaluate hospital outcomes, including mortality, in patients admitted with COVID-19 with and without epilepsy.

We conducted a retrospective study in a large multicenter New York health system comparing outcomes in patients with and without epilepsy admitted with COVID-19 between March 15, 2020 and May 17, 2021.

Patients with epilepsy were identified using a validated ICD-9-CM and ICD-10-CM based case definition.

Outcomes included level of respiratory support, ICU admission, and in-hospital mortality. Descriptive statistics were calculated. Chi-squared tests and t-tests were conducted to compare the demographics and outcomes between patients with and without epilepsy. Analyses adjusting for confounders (i.e. sociodemographic variables, comorbidities, COVID severity, calendar month, therapies received, serological markers and others) are in progress. Univariate analyses are presented below.

We identified 334 COVID-19 patients with and 9,499 without epilepsy. Patients with epilepsy were significantly younger than patients without epilepsy (mean 62 vs. 65 years old, p=0.02). Of those with epilepsy, 45% were female compared to 46% in those without epilepsy (p=0.674). Although there were more non-Hispanic Asians without epilepsy (5.7% vs 3.6%) and more non-Hispanic Blacks with epilepsy (27.8 vs 24.5%), race was not statistically different between the two groups. Patients with epilepsy had a significantly higher rate of ventilator respiratory support than those without epilepsy (37.7% vs. 14.3%, p < 0.001). Eighteen percent of patients with and without epilepsy were admitted to the ICU (epilepsy vs without epilepsy: 39.2% vs. 17.7%, p < 0.001). There was a significant difference in in-hospital mortality between patients with or without epilepsy (29.6% vs 19.9% respectively, p < 0.001).

Our study found a significant difference in in-hospital mortality, level of respiratory support, and need for ICU admission between COVID-19 patients with or without epilepsy in univariate analysis. Work is ongoing to determine factors associated with mortality in epilepsy.

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ABSTRACT 123 IDENTIFYING AND RECRUITING AMERICAN DESCENDANTS OF SLAVERY (ADOS) IN MEDICAL SCHOOL APPLICATIONS: AN ANTI-RACIST FRAMEWORK. Stephanie Urena1, Michelle Sainté Willis1, Ann-Gel Palermo1.

1 Medical Education. 1Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Recent AAMC diversity data shows that 6% of Medical School Graduates are Black or African American. The data is alarming and further compounded by the lack of clear definitions. There is growing debate whether to distinguish between African American and African immigrants even within medical school admissions. These groups may have different cultures, values, and historical context. This systematic review aims to assess current practices, identify and consider unique experiences of American Descendants of Slavery (ADOS) applicants. The objective is to develop recommendations, informed by an anti-racist framework, for medical school admission committees to identify and recruit ADOS applicants.

RESEARCH QUESTION: How to identify and recruit ADOS students applying to medical school using an anti-racist framework?

METHODS: Data was gathered for this review in 2020. A wide array of electronic databases were searched. Grey literature including lectures and correspondence with experts were also considered. The search strategy included literature on ADOS, Historically Black Colleges and Universities (HBCU), HBCU applications, reparations, and identifying Native American students on applications.

RESULTS: The search located 52 articles/presentations and 102 applications. Literature is limited on ADOS. There is contention with the use of ADOS even within medical school admissions. Evidence from the records resulted in five themes: recognizing ADOS identity; identifying and validating ADOS in higher ed including HBCU; expanding the definition of black student; using the ADOS identity to advocate for reparations and address injustices that ADOS continue to face in the US; and incorporating a holistic understanding of identity.

CONCLUSIONS: ADOS is a new concept and this review suggests there are key recommendations that can be used by admissions committees. Recommendations include a clear rationale for identifying and recruiting ADOS applicants, standard questions on medical school applications to determine ADOS status, and a framework for understanding how recruiting and retaining ADOS medical students can address the historical inequities rooted in systemic racism. Once this data is collected, medical schools have an opportunity to create pipeline programming and identify the protective factors that will increase the number of ADOS applicants and retain them in medical school.

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ABSTRACT 124 THE IMPACT OF STOOL FIT-DNA TESTING ON DISPARITIES IN COLORECTAL CANCER SCREENING. Roshan Vasoya1, Lina Jandorf2. 1Medical Education, 2Population Health Science and Policy.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Colorectal cancer (CRC) is the second highest cause of cancer death in the U.S. despite a decreasing incidence rate due to CRC screening in 50-75 year-olds. However, there are well-documented disparities in CRC screening. Stool FIT-DNA testing was introduced in 2014, detecting both molecular markers in sloughed cells and blood in stool for CRC. It is less invasive than colonoscopy and requires testing every 3 years, not annually like other fecal tests, thus it is preferential for some older adults reluctant to undergo a colonoscopy.

OBJECTIVE: To identify disparities within adults screened with this new modality.

METHODS: All Stool FIT-DNA orders from 3/2019 - 4/2021 in the Mount Sinai health system were used.

Status of the tests and patient demographics including age, sex, race (African American, Asian, Other, or White), language (English, Spanish, Other, or unknown), and insurance (Public, Private, or None), were collected from patient charts. Multivariable logistic regression was used to determine if there are disparities related to completion of the test and completion of follow-up screening when the Stool FIT-DNA test is positive, as per USPSTF guidelines. Demographic variable inclusion was based on univariate Chi-Squared tests or one-way ANOVA with α = 0.2. Statistical tests were run with SPSS v24.

RESULTS: 51.5% of patients where a Stool FIT-DNA test is ordered are screened per USPSTF guidelines.

Multivariable logistic regression shows that African American (OR 0.669; 95% CI 0.601-0.744) and other minority patients (OR 0.814; 95% CI 0.737-0.900) are less likely to complete Stool FIT-DNA tests, while privately insured patients (OR 1.352; 95% CI 1.242-1.472) and older patients (OR 1.012; 95% CI 1.007-1.016) are more likely. African American (OR 0.594; 95% CI 0.383-0.981) and other minority patients (OR 0.646; 95% CI 0.446-0.936) are less likely to have diagnostic screening following a positive Stool FIT-DNA test. African American (OR 2.549; 95% CI 2.022-3.212), other minority (OR 2.293; 1.844-2.851), and Spanish-speaking (OR 1.604; 95% CI 1.222-2.104) patients are more likely to have an inconclusive test result.

CONCLUSIONS: These findings show non-Asian minority patients are less likely to be screened for CRC

by Stool FIT-DNA, and suggest a greater need of outreach to minority and non-English speaking patients regarding CRC screening.

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ABSTRACT 125 PROTOCADHERIN-7 REGULATES CONTRACTILITY OF MURINE HEPATIC STELLATE CELLS. Nicholas Venturini1, James Carter2, Scott Friedman2. 1Medical Education, 2Medicine.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Activation of hepatic stellate cells (HSCs), the predominant fibrinogenic cells of the liver, is a hallmark of liver fibrosis. HSCs are also highly contractile and known to contribute to portal hypertension in chronic liver disease. A screen of HSC-expressed membrane proteins identified protocadherin 7 (PCDH7) as a novel candidate for further investigation. Although the function of PCDH7 in healthy adult tissues has not yet been characterized, closely-related members of the protocadherin family are involved in mechanotransduction and regulation of the actomyosin cytoskeleton.

HYPOTHESIS: PCDH7-knockout (KO) HSCs will exhibit impaired contractility when compared to PCDH7-wildtype (WT) HSCs using a standard collagen gel contraction assay.

METHODS: PCDH7 WT and PCDH7 KO murine HSCs were embedded within a collagen disc (1 mg/mL rat tail collagen I and 2x10^5 cells/mL) in order to model HSC contractility. The gels were cast at room temp, then allowed to float in a 10 cm dish filled with complete culture medium (10% FBS DMEM) to stimulate contraction. Contraction was assessed at 24-hour intervals for 5 days and quantified using ImageJ software.

Cell morphology was studied as an indicator of HSC activation status. After 5 days, surviving cells were released by dissolving the gels with collagenase B. RNA was extracted from these cells and sent for bulk RNA sequencing.

RESULTS: PCDH7 KO HSCs exhibited significantly attenuated contractility at day 5 (85% contraction in WT HSCs versus 5% contraction in KO HSCs, t-test, p <0.0001). Analysis of cell morphology showed fewer cytoplasmic projections and a rounded appearance in KO HSCs, suggesting less HSC activation. Consistent with this finding, bulk RNA sequencing revealed reduced activation-associated gene expression in KO HSCs (Acta2, Col1a1, Col1a2).

CONCLUSION: PCDH7 regulates contractility in cultured murine HSCs, linking adhesion molecule engagement to HSC activation. Based on this data, additional studies will be conducted to determine if reconstitution of PCDH7 expression in KO HSCs can rescue contractility in culture, to explore potential mechanisms of PCDH7 activity, and to clarify if these observations extend to healthy and diseased livers in vivo.

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ABSTRACT 126 DISPARITIES IN ACCESS TO CARDIOVASCULAR PREVENTIVE SERVICES

BY SOCIOECONOMIC STATUS. Hannah Verma1, Jonathan Hong2, Shiwani Mahajan3, Reed Mszar3, Gowtham Grandhi4, Nihar Desai5, Salim Virani6, Khurram Nasir6, Javier Valero7. 1Medical Education, 2,7Cardiovascular Surgery. 4Medicine. 1Icahn School of Medicine at Mount Sinai, New York, NY, 2Northwestern University, 3Yale New Haven Health, 4 MedStar Union Memorial Hospital, 5Yale School of Medicine, New Haven, CT. 6Michael E. DeBakey Veterans Affairs Medical Center, 7Houston Methodist DeBakey Heart and Vascular Center.

BACKGROUND: Disparities in cardiovascular outcomes are persistent in our society.

OBJECTIVE: To track the trends before and after the passage of the Affordable Care Act in socioeconomic status (SES) disparities in access to CVD-related preventive services among nonelderly adults aged 18-64 years.

METHODS: We used the National Health Interview Survey (2011-17) to compare utilization of: blood pressure, cholesterol, blood sugar checks, and diet and smoking cessation advice over time between groups stratified by socioeconomic status and race using difference-in-difference analysis. In addition, we also measured the differences over time in specific vulnerable population subgroups (Hispanic, low-income and uninsured vs White, middle-high income and insured).

RESULTS: Our study population included 176,961 surveyed individuals (mean age 40 [±13] years; 51% female; 67.7% non-Hispanic white) between 2011 and 2017, translating to 194.8 million non-elderly US adults per year.

Most individuals were from high-income SES (40.0%), followed by middle-income (28.1%), lowest-income (18.3%), and low-income (13.6%). The proportion of CVD-related preventive services increased over all SES categories through the study period. The biggest relative changes were seen among low-income individuals.

The difference in blood pressure checks, cholesterol checks, and smoking cessation advice between highand lowest-income groups showed a statistically significant decrease at 5.2%, 4.8%, and 11.2%, respectively between 2011 and 2017.

CONCLUSIONS: Our findings demonstrate a trend in reduction of CVD-related preventive care disparities between SES groups. However, a gap still exists, and the current study highlights the need for continuous improvement to eliminate SES disparities.

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ABSTRACT 127 FAILURES OF CARDIOVASCULAR HEALTH POLICY IN SOUTHERN STATES: TRENDS IN GEOGRAPHIC DISPARITIES IN UTILIZATION OF CARDIOVASCULAR PREVENTIVE SERVICES. Hannah Verma1, Stephen Latham2. 1Medical Education, 2Bioethics. 1Icahn School of Medicine at Mount Sinai, New York, NY, 2Yale University, New Haven, CT. BACKGROUND: States in the Southern United States tend to have elevated mortality from cardiovascular disease (CVD). The Southern region also has the largest proportion of states that have not expanded Medicaid eligibility, leaving a large gap in insurance coverage and lack of access to free CVD preventive services for much of the population. Reasons for poor CVD metrics in the South have not been explored in the literature.

RESEARCH QUESTION: Why do patients in the South have an increased chance of CVD risk factors and CVD? METHODS: We examined data from the Medical Expenditure Panel Survey (MEPS) collected by the Agency for Healthcare Research and Quality (AHRQ) across a 10-year period from 2008 – 2017 among adults aged 18-64 to compare the percentage of smokers who were advised to quit smoking and the percentage of smokers who were not advised to quit smoking, between geographic regions. We also compared the percentage of patients with diabetes who were advised to reduce fat in their diet, by both geographic region and race. Historical and political research was examined to gauge the current Southern social and political climate as it pertains to CVD. RESULTS: Current adult smokers in the South (M = 49.086, SD = 2.107) compared to people in the Northeast (M = 57.571, SD = 3.881) experienced a significantly lower rate of tobacco cessation advice, t(12) = 5.0845, p = 0.0003, while current adult smokers in the South (M = 28.943, SD = 2.952), compared to people in the Northeast (M = 23.443, SD = 2.918), experienced a significantly lower failure rate for tobacco cessation advice, t(12) = 3.5054, p = 0.0043. While racial and geographic differences in dietary counseling were not statistically significant, there seemed to be clinically significant variations between racial groups, both within the South and between the South and Northeast. Heart disease events showed a smaller decline in the South compared to the Northeast. Political precedent suggests a lack of prioritization of CVD-oriented health policy.

CONCLUSION: Southern states have largely been reluctant to implement Medicaid expansion, but it will play an important role in enabling patients to receive free preventive services from their physicians. Because patient-reported rates of these services are especially low in the South, Southern states would especially benefit from key reforms to cessation services coverage, increased barriers to smoking, and more accessible food services.

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ABSTRACT 128 IMPACT OF VIRTUAL-REALITY-GUIDED MINDFULNESS ON FOCUS PRIOR TO HIGH-FIDELITY SIMULATION DEBRIEF. Brett Weingart1, Garrett Burnett2, Stephanie Hojsak2, Daniel Katz2. 1Medical Education, 2Anesthesiology.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: High-fidelity simulation (HFS) is commonly used to train anesthesiology residents in how to perform in high-stress situations. Previous studies have shown physiologic stress responses during HFS may enhance performance during subsequent high-intensity scenarios, however this level of stress may hinder focus and knowledge retention during a post-HFS debrief session. Currently, the optimal mindset to maximize learning during the debrief is unknown and the ideal modality to create this mindset after a stress-inducing session has not been determined.

OBJECTIVE: This study aims to examine changes in focus and anxiety in anesthesia PGY-2 residents immediately after a guided meditation session, either with or without virtual reality (VR) supplementation, previously used in mindfulness exercises. We hypothesized that meditating with VR would lead to a more successful meditation and a larger increase in focus and decrease in anxiety than meditating without VR. METHODS: 26 anesthesiology PGY-2 residents completed twice-weekly HFS sessions. Immediately after the HFS session and before a standardized debrief, they completed a 5-minute mindfulness exercise guided by the Muse EEG headband. Half of the residents wore a VR headset and meditated in a virtual forest environment, while the other half meditated with their eyes closed. Immediately before and after meditating, they completed a brief anxiety and focus questionnaire, then participated in a standardized debrief on the HFS session. Changes in focus and anxiety after meditating (self-reported) were compared between the two groups, as well as composite EEG scores between the two groups.

RESULTS: Analysis showed no significant differences between two groups regarding baseline anxiety levels or composite EEG scores prior to investigation. There were no significant differences between the groups’ increase in focus (VR group 4.8, Control 8.1, p=0.62) and reduction in anxiety (VR group -16.4, Control -21.1, p=0.39) after meditating. However, significantly, regardless of VR supplementation, meditation reduced anxiety levels by about 19% (p < 0.0001). Focus levels did not change after meditation.

CONCLUSIONS: The addition of VR had no effect on the quality of meditation or on changing the resident’s mental state. Meditation led to reduced anxiety levels across all groups, suggesting that meditation of any form is useful before HFS debrief in reducing stress, but the addition of VR may be unnecessary.

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ABSTRACT 129 WHAT FACES REVEAL: THE LEGACY OF HUGH DIAMOND'S PHOTOGRAPHIC REPRESENTATIONS OF MENTAL ILLNESS. Sara Wetzler1, James Curely-Egan2. 1Medical Education, 2Psychiatry.

1,2 Icahn School of Medicine at Mount Sinai, New York, NY. Hugh Diamond was a psychiatrist, antiquarian, and photographer, who was the first person to take photographs of female asylum patients. These photographs, using the newly invented technology of the camera, were intended to be objective and accurate visual indicators of mental illness. Considering Diamond’s overlapping interests, his project must be understood within the larger cultural and historical context and the tensions inherent in medical photography and portraiture. Despite the goal of capturing “objective, scientific data,” the photographs instead relied on traditional iconography dating back to the Greeks and Middle Ages and can be analyzed from an art historical perspective. As an antiquarian, Diamond collected portraits of his patients just as he collected various other objects. As such, while Diamond may be considered a humanistic leader of the moral treatment movement, his work in capturing these “specimens,” the female patients, reflects a perpetuation of the stigmatization of mental illness to be put on display for the Victorian audience.

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ABSTRACT 130 HOW DOES SMOKING TOBACCO IMPACT LONG-TERM OUTCOMES FOLLOWING TOTAL SHOULDER ARTHROPLASTY? Christopher White1, Akshar Patel2, Kevin Wang2, Carl Cirino2, Benjamin Gross2, Bradford Parsons2, Evan Flatow2, Paul Cagle2. 1Medical Education, 2Orthopaedics. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Outcomes following anatomic total shoulder arthroplasty (aTSA) can be significantly affected by preoperative health factors. Cigarette smoking in particular is a modifiable risk factor associated with higher complication and revision rates and worse postoperative pain scores.

METHODS: The charts of patients who underwent aTSA were retrospectively analyzed and stratified based on smoking status. The primary data included range of motion (ROM) (i.e. forward elevation, external rotation, internal rotation) and patient reported outcomes (PROs) (i.e. Simple Shoulder Test (SST), American Shoulder and Elbow Surgeon (ASES), Visual Analog Scale (VAS) scores). Radiographic (i.e. lateral humeral offset, acromiohumeral interval, humeral radiolucency) and demographic analyses were also conducted. All data were analyzed using inferential statistics.

RESULTS: There were 78, 49, and 16, non-smoker, former smoker, and current smoker shoulders respectively with no significant differences in sex, ASA status, BMI, or mean follow-up time between the groups (average: 10.7 yrs.). Smokers (51.5 ± 10.4 years) were younger than both non-smokers (64.9 ± 8.1 years; p<0.01) and former smokers (65.1 ± 9.1years; p<0.01) at the time of surgery. For non-smokers and former smokers, all ROM and PRO scores significantly improved. Smokers reported significant improvements in all PROs and external and internal rotation; VAS, ASES, and SST scores were lower for smokers comparatively, but these differences did not reach significance. Forward elevation was higher postoperatively for nonsmokers (149.7o ± 17.2o) and former smokers (147.1o ± 26.0o) compared to current smokers(130.9o ± 41.2o) (p=0.017). No differences were found in a radiographic analyses of the cohorts. Revision rates were lower in the non-smoking cohort (7.7%) compared to former smokers (20.4%; p=0.035) and current smokers (31.3%; p=0.019). Survival curves showed that non-smoker implants lasted longer than those of current smokers (p=0.014).

CONCLUSION: At 10.7 years follow-up, we saw that patients generally had improved shoulder ROM, functionality, and pain regardless of smoking status. However, current smokers required shoulder replacements at younger ages and revision surgery more frequently. Given the potential risks for revisions in the long-term, surgeons should continue to address smoking status as a potential surgical risk factor at consultations.

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ABSTRACT 131 ASSOCIATION BETWEEN SERUM VITAMIN D LEVELS AND MYOPIA IN THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY (2001-2006).

Amber Wolf1, Louis Pasquale2, Bian Liu3, Sumayya Ahmad2. 1Medical Education, 2Ophthalmology, 3 Population Health Science and Policy. 1,2,3Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Myopia increases one’s risk for serious ocular conditions including retinal damage, glaucoma, and cataracts, and its prevalence has doubled in the last 30 years in the U.S. OBJECTIVE: To assess the relationship between serum vitamin D levels and presence of myopia in people aged 12-49 years using the National Health and Nutrition Examination Survey (NHANES) database.

METHODS: Demographics, vision, and vitamin D data from NHANES (2001-2006) were analyzed.

Multivariate analyses were performed to examine the relationship between myopia and serum vitamin D levels while controlling for sex, age, ethnicity, education level, and poverty status. Subjects were excluded if they had previous refractive surgery, cataracts surgery, or were pregnant at the time of exam. A total of 11,669 participants were included in the analysis. Main Outcomes and Measures: Presence or absence of myopia, defined as a spherical equivalent of -1 diopters or more myopic.

RESULTS: Of the 11,669 participants, 5,310 (45.5%) had myopia. The average serum vitamin D concentration for the myopic group was 61.6 ± 0.9 nmol/L and 63.1 ± 0.8 nmol/L for the non-myopic group (p = 0.01).

Multivariate regression results demonstrated that subjects with myopia had 0.25 ± 0.08 nmol/L less serum vitamin D than subjects without myopia (p = 0.0007). Though there was no statistically significant relationship between serum vitamin D and spherical equivalent as a continuous variable, the proportion of participants with myopia decreased with increasing serum levels of vitamin D. CONCLUSIONS: Participants with myopia, on average, had lower serum concentrations of vitamin D compared to those without myopia. While further studies are needed to determine the mechanism, this study suggests that elevated vitamin D levels may have protective effects against the onset or progression of myopia.

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ABSTRACT 132 “I DEPEND ON HER FOR EVERYTHING": CHARACTERIZING THE ROLE OF HOME CARE WORKERS CARING FOR HOMEBOUND OLDER ADULTS DURING THE COVID-19 PANDEMIC THROUGH A MIXED-METHODS STUDY. Emily Xu1, Patricia Kim2, Cynthia Yee2, Meng Zhang3, Jennifer Reckrey2, Sara Lubetsky2, Katherine Ornstein2, Emily Franzosa2. 1Medical Education, 2Geriatrics and Palliative Medicine, 3Medicine.

1,2,3 Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: The devastating impact of the COVID-19 pandemic on long term care facilities has made the need for quality home-based care for homebound older adults clear. Home care workers (HCWs) have played a critical role in keeping homebound older adults safely at home during COVID-19, yet their essential work is often undervalued and understudied.

OBJECTIVE: The purpose of this study was to illustrate the roles of HCWs during COVID-19 and how HCW service disruptions impacted patients and their caregivers.

METHODS: In this mixed-methods study, we collected demographic and clinical data and performed a thematic analysis of medical records from 53 homebound patients with HCWs in the Mount Sinai Visiting Doctors Program, a home-based primary care program in New York City. We abstracted unstructured clinical notes between 12/1/2019 through 12/31/2020 into a priori and emergent categories, including changes to HCW responsibilities and disruptions to HCW services, and identified core themes via discussion in team meetings.

RESULTS: Of the 53 patients, 24.5% died during the initial COVID surge, 34% lived alone, and 41.5% had 24-hour HCWs. The mean Elixhauser Comorbidity Index was 3.66. Five themes emerged from our analysis: 1) Changes to HCW roles included taking on new medical tasks and increased intensity of existing tasks (e.g., managing progressing dementia behaviors), 2) Delays in staffing and risk of COVID exposure contributed to changes in HCW hours and continuity, including unexpected loss of services, 3) Disruptions in HCW services put patients at risk of hospitalization and nursing home placement due to safety concerns, 4) Payment structure and patient preferences made it challenging to get sufficient hours of paid care, and 5) Lack of adequate and quality HCW services created additional caregiver responsibilities, contributing to caregiver burden.

CONCLUSIONS: During COVID-19, HCWs were essential in keeping homebound older adults safely at home. Inadequate HCW services disrupted care for these medically and socially complex patients. Unstable schedules and inadequate hours of paid care became particularly disruptive in the setting of COVID-19, leading to risk of hospitalization and prolonged length of stay. Ultimately, this analysis can inform policies that encourage better integration of HCWs on medical teams and address workforce shortages to expand access to adequate HCW services for homebound older adults and their caregivers.

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ABSTRACT 133 ADVANCED AGE AS A RISK FACTOR FOR PERIOPERATIVE COMPLICATIONS AND 30-DAY AND 90-DAY READMISSIONS IN PATIENTS UNDERGOING SINGLE LEVEL ANTERIOR CERVICAL DISCECTOMY AND FUSION. Brandon J. Yeshoua1, Sirjanhar Singh 3, Helen Liu1, Nima Assad1, Sara D. Pasik1, Justin E. Tang1, Akshar Patel1, Kush C. Shah1, William Ranson2, Jun S. Kim2, Samuel K. Cho2.

1 Medical Education, 2Orthopedics. 1,2Icahn School of Medicine at Mount Sinai, New York, NY, 3 Orthopaedics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. OBJECTIVE: To assess perioperative complication rates and readmission rates following ACDF in a patient population of advanced age (≥75 years old).

METHODS: This is a retrospective analysis of patients 18 years of age and older who underwent elective single-level ACDF were identified in the HCUP-NRD and stratified into four cohorts: 18-39 (“young”), 40-64 (“middle”), 65-74 (“senior”), and 75+ (“elderly”) years of age. For each cohort, the perioperative complications, frequency of those complications, and number of patients with at least one readmission within 30 and 90 days of discharge were analyzed. Chi-squared tests were used to calculate perioperative complications and 30- and 90-day readmissions.

RESULTS: There were 1174 “elderly” patients in 2016, 1072 in 2017, and 1010 in 2018 who underwent ACDF. Their rate of any complication was 8.95%, 11.00%, and 13.47% respectively (P<.0001), with dysphagia and acute-posthemorrhagic anemia being the most common across all three years. They experienced complications at a greater frequency than their younger counterparts (15.80%, P<.0001; 16.98%, P<.0001; 21.68%, P<.0001). They also required 30-day and 90-day readmission more frequently (P<.0001) (Table 4-5).

CONCLUSION: It has been well-established that advanced patient age brings greater risk of perioperative complications in ACDF surgery. What remains unsettled is the characterization of this age-complication relationship and at which age should ACDF be avoided due to unacceptable risk. Our study suggests that readmission and complication rates following ACDF increase with advancing age. Studies should investigate the presence of an inflection point in the form of a specific age at which single-level ACDF becomes contraindicated.

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ABSTRACT 134 CHOROIDAL EFFUSIONS REQUIRING SURGICAL INTERVENTION FOLLOWING GLAUCOMA DRAINAGE IMPLANT SURGERY: RISK FACTORS AND MANAGEMENT. Stephanie Ying1, Sara Coulon2, Alcina Lidder2, Mary Labowsky3, Kateki Vinod3, Paul Sidoti3, Joseph Panarelli2. 1Medical Education, 2,3Ophthalmology. 1Icahn School of Medicine at Mount Sinai, New York, NY, 2NYU Langone, 3New York Eye and Ear Infirmary.

BACKGROUND: Choroidal effusion, the abnormal accumulation of serous fluid in the suprachoroidal space, is one of the most common complications of glaucoma surgery, including glaucoma drainage implant (GDI) surgery. Depending on the procedure, the incidence of postoperative choroidal effusion ranges from 7.9% to 18.8%. Although choroidal effusions are often benign, they can result in significant visual loss if they obstruct the visual axis or produce anterior rotation of the lens-iris diaphragm. They also increase the risk of suprachoroidal hemorrhage, which carries a much worse visual prognosis. Although studies have identified risk factors for the development of choroidal effusions, a gap in the literature exists regarding predisposing variables and outcomes of effusions requiring surgical intervention following GDI surgery.

OBJECTIVE: To evaluate the risk factors for and outcomes of choroidal effusions requiring surgical intervention following GDI surgery. We hypothesized that factors such as implant type, effusion characteristics, and management approach (i.e., medical or surgical) might affect the effusion severity and outcome.

METHODS: This was a retrospective case series that examined the medical records of all patients who underwent GDI surgery from Jan. 1, 2017 - June 7, 2021 at New York University (NYU) Langone and New York Eye and Ear Infirmary of Mount Sinai (NYEE). Patients who developed postoperative choroidal effusions were identified. Preoperative, intraoperative and postoperative clinical data including demographic information, past ophthalmic history, surgical characteristics, visual acuity (VA) and intraocular pressure (IOP) measurements were obtained.

RESULTS: Choroidal effusions developed in 123 eyes (116 patients). Surgical intervention to drain the effusion was performed in 44 (36%) of these eyes. Factors associated with a need for surgical drainage were evaluated via a multivariate logistic regression. These included history of selective laser trabeculoplasty (SLT) (p=0.027), implantation of 350-mm2 Baerveldt Glaucoma Implant (BGI-350; Johnson & Johnson Vision, Santa Ana, CA, USA) (p=0.032), and a higher IOP at effusion onset (p=0.015). Eyes that required surgical drainage had the lowest visual acuity during the effusion course compared to eyes that resolved on more conservative treatments (p<0.001, Kruskal Wallis). However, there were no differences in visual acuity and IOP across all treatment groups at choroidal effusion resolution.

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ABSTRACT 135 PREDICTIVE POWER OF MACHINE LEARNING MODELS IN FECAL MICROBIOTA TRANSPLANT FOR INFLAMMATORY BOWEL DISEASE. David Youssef1, Matthew Stapylton2, Jose Clemente2. 1Medical Education, 2 Genetics and Genomic Sciences. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Fecal microbiota transplants (FMTs) involve transferring microbial populations from a healthy individual to a patient. This serves as an effective treatment for Clostridium difficile infections, but not much is known regarding how generalizable this approach is for conditions such as inflammatory bowel disease (IBD), nor to what extent the engraftment of the microbiome in the recipient might drive outcomes.

METHODS: We used data from the FOCUS study, a clinical trial of FMT in 81 IBD patients, to identify microbial biomarkers remission. The patients had Ulcerative Colitis and were randomized to receive either a FMT or placebo transplants with endpoints of clinical and histological remission. The primary endpoint was at the 8 week mark. The secondary endpoint included patients from the placebo arm that didn’t respond who were permitted to undergo the FMT. We constructed machine learning models based on the microbiome of donors and patients pre- and post-transplantation to predict response, as defined by clinical and histological remission. These models were implemented using scikit-learn’s SVMs with linear kernel, random forest (RF), gradient boosting, and logistic regression (LR). The training and test sets were constructed using repeated stratified K fold and 100 iterations were done. The performance of each model was measured and compared across 4 subsets of the full dataset based on endpoints using ROC curves and the area under the curve (AUC, mean +/- SD).

RESULTS: The majority of metrics supported RF as producing the best prediction of response. The subset that includes patients receiving FMT or placebo had SVM with the highest AUC of 0.69 +/- 0.17 when predicting outcome for the primary endpoint. The complete set of samples had RF with the highest AUC of 0.63 +/- 0.12 when predicting outcomes for either endpoint. The subset that included only those that received the FMT first had RF and LR with the highest AUC of 0.78 +/- 0.16 and 0.18 when predicting outcomes for the primary endpoint, respectively. The last subset, which included only those who received the FMT, had RF with the highest AUC of 0.65 +/- 0.15 when predicting outcomes for either endpoint.

DISCUSSION: Overall, RF produced the most accurate models for our data. This result is expected given the small number of subjects and the large number of features, since RF is known to perform best under these conditions. Future work will compare how each method performs on other datasets.

171

ABSTRACT 137 DYNAMIC IMAGING OF VITREOUS CORTEX HYALOCYTES USING ADAPTIVE OPTICS SCANNING LIGHT OPHTHALMOSCOPY IN HUMAN SUBJECTS. Rebecca Zhou1, Justin Migacz2, Richard Rosen2, Toco Y.P. Chui2. 1Medical Education, 2 Ophthalmology. 1Icahn School of Medicine at Mount Sinai, New York, NY, 2 New York Eye and Ear Infirmary at Mount Sinai, New York, NY. Hyalocytes are resident macrophages located on the cortical layer of the vitreous body that play a role in responding to tissue damage and inflammation on the retinal surface. Recent studies have shown that hyalocytes can be visualized non-invasively using laboratory and commercially available optical coherence tomography (OCT) and Adaptive optics-OCT (AO-OCT) equipment. However, successful quantitative measurements of hyalocyte movement over shorter time scales have yet to be achieved. Adaptive optics scanning light ophthalmoscopy (AOSLO) is a non-invasive, point-scanning imaging technique capable of video-rate visualization of tissues at a cellular level; we hypothesized and demonstrated that quadrantdetection AOSLO could allow for detailed in vivo identification and visualization of hyalocyte movement on the vitreoretinal interface in healthy humans. We characterized hyalocyte motility and displacement in one eye each of 8 subjects with no known retinal pathology (age mean±stdev: 28.6±3.7 years; range: 24-35 years; 6 males, 2 females) over two time scales: in 5-minute intervals at a single region of interest (ROI) for our 1-hour protocol (n=3; 14 cells total) and in 30-minute intervals at 3 or more ROIs for our 2-hour protocol (n=8; 93 cells total). These time intervals allowed us to locate and record 2 or more acquisitions of 300 sequential AOSLO frames at each ROI while providing subjects a short period of rest in between acquisitions. Cells exhibited variability in total distance traveled, with the mean±stdev cumulative path length of 30.9±24.4 µm (range 7.194.2 µm) for cells in the 1-hour protocol and 28.4±27.1 µm (range 2.9-194.1 µm) for cells in the 2-hour protocol.

The average velocity of the cells was 0.52±0.76 µm/min and 0.24±0.29 µm/min for cells in the 1- and 2-hour protocols, respectively. Individual cell trajectories suggested hyalocytes typically moved in short bursts and frequently changed direction, and that hyalocytes may alternate between resting and activated states, during which cells traveled relatively shorter or longer distances between intervals. Understanding in vivo vitreous cortex hyalocyte behavior under normal physiological conditions using quadrant-detection AOSLO may pave the way to uncovering biomarkers or suitable therapeutical targets in various retinal diseases such as diabetic retinopathy and glaucoma.

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ABSTRACT 138 TRANSCAROTID ARTERY REVASCULARIZATION IS ASSOCIATED WITH REDUCED ADVERSE IN-HOSPITAL EVENTS AND BETTER LONG-TERM SURVIVAL COMPARED TO TRANSFEMORAL CAROTID ARTERY STENTING. Jerry Zhu1 , Ajit Rao2. 1Medical Education, 2Surgery. 1,2Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Transcarotid artery revascularization (TCAR) is an operative revascularization approach used to treat carotid artery stenosis and combines aspects of surgical carotid endarterectomy and transfemoral carotid artery stenting (TFCAS). Research on adverse events following TCAR among symptomatic and asymptomatic carotid artery stenosis patients is limited.

OBJECTIVE: We compare the association of symptom status with in-hospital outcomes and long-term survival after TCAR to TFCAS. METHODS: Data was analyzed from patients in the Vascular Quality Initiative database undergoing TCAR (Jan 2017 to Apr 2020) or TFCAS (May 2005 to Apr 2020). Symptomatic status was defined as transient ischemic attack (TIA) and/or stroke within 180 days prior to procedure. Adverse in-hospital outcomes were analyzed with Chi-Square and 3 year survival was estimated using Kaplan-Meier. Multivariate logistic regression and Cox regression were used to adjust for significant between-group differences in baseline characteristics.

RESULTS: 7,158 patients underwent TCAR (symptomatic: 2,574, asymptomatic: 4,584) and 18,023 patients underwent TFCAS (symptomatic: 6,195, asymptomatic: 11,828). TCAR patients were generally older, white, previously smoked, and had more comorbidities than TFCAS. Among both asymptomatic and symptomatic patients, TCAR was associated with a significant decrease in the odds of in-hospital stroke (asymptomatic OR: 0.54, 95% CI: 0.38-0.77, P<.001; symptomatic OR: 0.63, 95% CI: 0.46-0.87, P=0.004) and TIA/stroke (asymptomatic OR: 0.56, 95% CI: 0.42-0.76, P<.001; symptomatic OR: 0.63, 95% CI: 0.48-0.82, P<.001) compared with TFCAS. TCAR was also associated with decreased odds of death (OR: 0.40, 95% CI: 0.21-0.76, P=0.005), stroke/ death (OR: 0.47, 95% CI: 0.34-0.65, P<.001), and stroke/death/MI (OR: 0.53, 95% CI: 0.40-0.71, P<.001) among asymptomatic patients. An even greater decrease in the odds of death (OR: 0.18, 95% CI: 0.10-0.30, P<.001), stroke/death (OR: 0.41, 95% CI: 0.31-0.54, P<.001), stroke/death/MI (OR: 0.45, 95% CI: 0.35-0.58, P<.001) was observed among symptomatic patients. Specifically, TFCAS was associated with increased rate of in-hospital death among symptomatic patients (2.7%) compared to asymptomatic patients (0.6%).

At 3 years, TCAR was associated with a 42% reduction in hazard (HR: 0.58, 95% CI: 0.48-0.71, P<.001) compared to TFCAS. Asymptomatic patients also benefited with a 36% reduction in hazard (HR: 0.64, 95% CI: 0.53-0.78, P<.001).

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ABSTRACT 139 OVARIAN RESERVE AND OOCYTE STIMULATION RESPONSE BETWEEN PATIENTS UNDERGOING ONCOFERTILITY PRESERVATION COMPARED TO NON-CANCER PATIENTS. Alexis L. Zachem1, Devora Aharon2, Alan Copperman2. 1Medical Education, 2Medicine.

Icahn School of Medicine at Mount Sinai, New York, NY. BACKGROUND: Whether there is a significant difference in ovarian reserve or cycle outcomes in oocyte cryopreservation between patients undergoing fertility preservation for cancer (Oncofertility) and patients without cancer is currently not well understood. Once differences or similarities between these metrics are established, the potential causes can be determined as well. It is possible that anything from underlying cancer pathology to physician bias affects response to stimulation and oocyte maturation.

Knowledge of differences in outcomes and potential causes will better inform counseling to cancer patients seeking fertility preservation.

RESEARCH QUESTION: Do patients with a prior cancer diagnosis have different ovarian reserve status or response to stimulation compared with patients without any cancer diagnosis?

METHODS: Using a retrospective cohort approach, ovarian reserve and response to stimulation can be assessed on the basis of basal estradiol, FSH, oocytes and mature oocytes retrieved and ratio of MII to oocytes received. Oncofertility and control patients will be matched for age, BMI, insurance coverage, AMH, BAFC and basal FSH. This information can be retrieved from charts and patient history must be assessed to exclude any patients with conditions that may confound their ovarian reserve (endometriosis diagnosis or history of ovarian surgery). Comparative statistics will identify significant differences between oncofertility patients and controls; linear regression will compare cycle outcomes.

RESULTS: A total of 187 cancer patients who underwent fertility preservation were identified and included in the analysis, matched to 374 controls. 146 patients had breast cancer (75.4%), 19 had hematologic cancers (10.2%), 14 had endometrial/cervical cancers (7.5%), and 13 had other cancers (6.9%). Oncofertility patients were similar to controls in terms of age, BMI, AMH, BAFC, and basal FSH. Oncofertility patients had significantly higher bE2 (62.4 ±56.1 vs. 46.0 ±33.0, p=0.001). Number oocytes retrieved was similar between oncofertility and elective egg freezers (15.5 ±11.7 vs. 13.6 ±8.8, respectively, p=0.41). Oncofertility patients had significantly lower number of MIIs retrieved (9.44 ±9.37 vs. 9.71 ±7.06, p=0.0296) and MII/oocyte ratio (0.59 ±0.29 vs. 0.70 ±0.22, p=<0.0001).

CONCLUSION: Oncofertility patients had similar ovarian reserve testing and oocytes retrieved, however the ratio of mature oocytes to total oocytes retrieved was lower compared to controls.

174

175

SECTION 3:

Student Index 176 176

STUDENT INDEX STUDENT NAME

MENTOR NAME

DEPARTMENT/ INSTITUTION

POSTER POSITION

Adler, Ava

Celia Divino, MD

Surgery

1

Agrawal, Sahil

Anne Schaefer, MD, PhD

Neuroscience

2

Ahsanuddin, Sofia

Richard Rosen, MD

Ophthalmology

3

Alasadi, Husni

Jashvant Poeran, MD, Ph Saad Chaudhary, MD

Orthopaedics Orthopaedics

4

Allely, David

Ramon Parsons, MD, PhD

Oncological Sciences

5

Alpert, Lauren

Alison Lee, MD

Medicine, Pulmonary, Critical Care and Sleep Medicine, Pediatrics

6

Amakiri, Uchechukwu

Peter Henderson, MD

Surgery

7

Ardente, Lily

Marla Dubinsky, MD

Pediatrics, Gastroenterology Medicine, Gastroenterology

8

Asfaw, Zerubabbel

Linda Zhang, MD

Surgery

9

Athayde-Rizzaro, Nicholas

Mary Rojas, PhD

Medical Education

10

Avril, Amina

Melissa Mazor, PhD, MS, RN Cardinale Smith, MD, PhD

Medicine Medicine

11

Azad, Arman

Viviana Simon, MD, PhD

Microbiology

12

Bai, Halbert

Windsor Ting, MD

Surgery

13

Banashefski, Bryana

Rita Redberg, MD

Cardiology, UCSF

14

Bedoya, Nestor

Yassine Sassi, PhD

Pharmacology and Systems Therapeutics, Fralin Biomedical Research Institute at VTC (Virginia Tech)

15

Benson, Caroline

Ryan Ungaro, MD

Medicine

16

Bergstein, Suzannah

Mirna Chehade, MD, MPH

Pediatrics

17

Butler, Liam

Sheena Ranade, MD

Orthopaedics

18

Chakrani, Zakaria

David Forsh, MD

Orthopaedics

19

Charytonowicz, Daniel

Robert Sebra, PhD

Genetics and Genomic Sciences

20

Chennareddy, Sumanth

Emma Guttman, MD, PhD

Dermatology

21

Chennareddy, Susmita

Bart Ferket, MD, PhD

Population Health Science and Policy

22 177

STUDENT INDEX DEPARTMENT/ INSTITUTION Population Health Science and Policy

POSTER POSITION

Alexis Colvin, MD

Orthopaedics

24

Cloonan, Paige

Lauren Zajac, MD, MPH

Pediatrics

25

Coleman-Belin, Janet

Craig Katz, MD

Psychiatry

26

Rainier Soriano, MD

Geriatrics and Palliative Medicine

STUDENT NAME

MENTOR NAME

Cho, Logan

Jashvant Poeran, MD, PhD

Chu, Brennan

Colon Iban, Yhan

23

27 Jashvant Poeran, MD, PhD

Population Health Science and Policy

D'Ovidio, Tyler

Daniel Katz, MD

Anesthesiology

28

Dale, Brandon

Jian Jin, PhD

Pharmacology and Systems Therapeutics

29

David, Eden

Emma Guttman, MD, PhD

Dermatology

30

David, Navindra

Dimosthenis Pandis, MD

Cardiovascular Surgery

31

Dominy, Calista

Aldo Londino, MD

Otolaryngology

32

Dubois, Bethany

Noura Abul-Husn, MD, PhD

Genetics and Genomic Sciences

33

Dullea, Jonathan

Raj Shrivastava, MD

Neurosurgery

34

Alexandra Livanos, MD, PhD

Medicine

Saurabh Mehandru, MD

Medicine Obstetrics, Gynecology, and Reproductive Science Pediatrics, Pulmonary and Critical Care, Environmental Medicine & Public Health, Medicine, Pulmonary, Critical Care and Sleep Medicine Genetics and Genomic Sciences

Dunn, Alexandra

35

Eger, Annalise

Toni Stern, MD

Eitenbichler, Samuel

Rosalind Wright, MD, MPH

Forrest, Iain

Ron Do, PhD

Frisch, Miriam

Joseph Masci, MD

Medicine

39

Garcia, Mariely

David Sachar, MD

Medicine

40

Gates, Jennifer

Timothy Rice, MD

Psychiatry

41

36

37

38

178

STUDENT INDEX DEPARTMENT/ INSTITUTION Environmental Medicine & Public Health, Pediatrics

POSTER POSITION

Louis Pasquale, MD

Ophthalmology

43

Elizabeth Singer, MD, MPH

Emergency Medicine

44

Todd Hollon, MD

Neurosurgery, Michigan Medicine

STUDENT NAME

MENTOR NAME

Gaye, Alioune

Lauren Zajac, MD, MPH

Geduldig, Jack Gogerly-Moragoda, Mahalya

Gologorsky, Rachel

Eric Oermann, MD

42

45 Neurosurgery, NYU Langone Health

Gomez, Miguel

Supinda Bunyavanich, MD, MPH

Pediatrics

46

Griffee, Kevin

Rachel Vreeman, MD, MS

Global Health, Pediatrics

47

Gross, Aliza

Tatyana Kushner, MD

Medicine

48

Gross, Benjamin

Paul Cagle, MD

Orthopaedics

49

Hampton, Rollie

Sarah Stanley, MBBCh, PhD

Neuroscience

50

He, Celestine

Mary Catherine George, PhD

Neurology

51

Henson, Philip

Jun Kim, MD

Orthopaedics

52

Hernandez Antonio, Josimar

Craig Katz, MD

Medical Education

53

Herrera, Michael

Calin Moucha, MD

Orthopaedics

54

Hess, Skylar

Nils Hennig, MD, PhD

Pediatrics

55

Hrabarchuk, Eugene

Tanvir Choudhri, MD

Neurosurgery

56

Iruvanti, Suvruta

Serdar Farhan, MD

Medicine, Cardiology

57

Israel, Yonatan

Dimosthenis Pandis, MD

Cardiovascular Surgery

58

Akhil Vaid, MD

Genetics and Genomic Sciences

Jiang, Joy

Girish Nadkarni, MD, MPH

59

Medicine

Kakalis, Matina

M. Mercedes Perez-Rodriguez, MD, PhD

Psychiatry

60

Kalagara, Roshini

Christopher Kellner, MD

Neurosurgery

61

Kamat, Samir

Matthew Akiyama, MD

Medicine, Albert Einstein College of Medicine

62 179

STUDENT INDEX STUDENT NAME

MENTOR NAME

DEPARTMENT/ INSTITUTION

POSTER POSITION

Kaplan, Carly

Jonathan Ripp, MD, MPH

Medical Education

63

Khilnani, Calla

Peter Heeger, MD

Medicine

64

Khurana, Sonia

Leora Mogilner, MD

Pediatrics

65

Kiyam, Zainab

Jacob Appel, MD, MS, MPH

Psychiatry, Medical Education

66

Kohler, David

Maia Kayal, MD

Medicine

67

Kona, Niathi

Maida Galvez, MD, MPH

Kumar, Anish

Ann-Gel Palermo, DrPH Benjamin Ungar, MD

Lavin, Leore

Ana Pavel, PhD Emma Guttman, MD, PhD

Environmental Medicine & Public Health, Pediatrics Medical Education, Pediatrics Dermatology Dermatology Dermatology

68 69

70

Levantovsky, Rachel

Judy Cho, MD

Genetics and Genomic Sciences

71

Levy, Micah

Michael Palese, MD

Urology

72

Microbiology and Immunology, Hospital for Special Surgery Oncological Sciences, Genetics and Genomic Sciences

Li, Thomas

Theresa Lu, MD, PhD

Liebers, Matthew

Alessandro Lagana, PhD

Liu, Clifford

Bruce Gelb, MD

Pediatrics

76

Liu, Helen

Peter Taub, MD

Surgery

77

Lopera, Isabel

Benjamin Ungar, MD

Dermatology

78

Lopez, Christine

Ali Zaidi, MD

73

74

Aaron Baum, PhD

Medicine, Cardiology Pediatrics Global Health

Rachel Vreeman, MD

Global Health, Pediatrics

Malhotra, Simran

Rachel Vreeman, MD

Global Health, Pediatrics

81

Malle, Louise

Dusan Bogunovic, PhD

Microbiology

82

McCarthy, Lily

Tanvir Choudhri, MD

Neurosurgery

83

Magill, Elizabeth

79 80

180

STUDENT INDEX STUDENT NAME

MENTOR NAME

DEPARTMENT/ INSTITUTION

POSTER POSITION

McCroskery, Stephen

Weina Sun, PhD

Microbiology

84

Michaelson, Zahava

Alan Copperman, MD

Morgan, Alli

Jacob Appel, MD, MS, MPH

Okome, Oluwafeyikemi

Sze Wong, MD

Oseroff, Benjamin

Katherine Ornstein, PhD

Patel, Krishna

Emanuela Taioli, MD, PhD

Pero, Adriana

Kristen Brennand, PhD

Pierce, Charlotte

Timothy Rice, MD

Obstetrics, Gynecology, and Reproductive Science Psychiatry, Medical Education Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai Geriatrics and Palliative Medicine Population Health Science and Policy Neuroscience

85 86 87 88 89 90

Psychiatry

Jacob Appel, MD

Psychiatry, Medical Education

91

Pitaro, Nicholas

Jashvant Poeran, MD, PhD

Orthopaedics

92

Plaza-Jennings, Amara

Schahram Akbarian, MD, PhD

Psychiatry

93

Pujari, Amit

David Forsh, MD

Orthopaedics

94

Quinones, Addison

Andrei Holodny, MD

Rajasekaran, Vignesh

Scott Friedman, MD

Ramos, Ezequiel

Ksenia Gorbenko, PhD

Raymond, Hayley

Jashvant Poeran MD PhD

Reford, Emma

Christopher Kellner, MD

Ren, Jen

Ann-Gel Palermo, DrPH

Revankar, Rishab

Christopher Sayed, MD

Rios, Jeanette

Dinali Fernando, MD Ben McVane, MD

Radiology, Memorial Sloan Kettering Cancer Center Medicine, Liver Diseases, Pharmacological Sciences Population Health Science and Policy Population Health Science and Policy, Orthopaedics, Medicine Neurosurgery Medical Education, Pediatrics Dermatology, UNC Chapel Hill School of Medicine, Chapel Hill, NC Emergency Medicine Emergency Medicine

95 96 97 98 99 100 101

102 181

STUDENT INDEX DEPARTMENT/ INSTITUTION Geriatrics and Palliative Medicine Geriatrics and Palliative Medicine

POSTER POSITION

Celia Divino, MD

Surgery

105

Saffran, Nathaniel

David Goukassian, MD, PhD

Medicine, Cardiology

106

Sanghvi, Jay

Garrett Burnett, MD

Anesthesiology

107

Schneider, Remington

Linda Wang, MD

Medicine

108

Jashvant Poeran, MD, PhD

Orthopaedics

Brett Hayden, MD

Orthopaedics

Calin Moucha, MD

Orthopaedics

Linda Wang, MD

Medicine

STUDENT NAME

MENTOR NAME

Ritzer, Lukas

Claire Ankuda, MD, MPH

Roberts, Harley

Amy Kelley, MD

Rosowicz, Andrew

Shah, Kush Sherman, Jacob

103 104

109 110

Shin, Joo Yeon

Bachir Taouli, MD

Silvestri, Francesca

Andres Ramirez Zamudio, MD, MPH

Radiology, Translational and Molecular Imaging Institute, New York, NY Obstetrics, Gynecology, and Reproductive Science

Smolar, Zay

Kevin Munjal, MD, MPH

Emergency Medicine

113

Suarez-Rebling, Daniela

Anna Rommel, PhD

Psychiatry

114

Subramaniam, Varun

Churl-Su Kwon, MD, MPH

Neurosurgery

115

Sudhir, Sweta

Constantinos Hadjipanayis, MD, PhD

Neurosurgery

116

Syed, Shumayl

Jonathan Ripp, MD, MPH

Medicine

117

Tang, Justin

Samuel Cho, MD

Orthopaedics

118

Tiao, Justin

Alexis Colvin, MD

Orthopaedics

119

Todd, Rachel

Linda Zhang, CSW

Surgery

120

Tolani, Serena

Ufongene, Claire

Urena, Stephanie

Alison Lee, MD Allison Navis, MD Nathalie Jette, MD Michelle Sainté Willis, Ann-Gel Palermo, DrPH

Medicine, Pulmonary, Critical Care and Sleep Medicine, Pediatrics Neurology Neurology Medical Education Medical Education, Pediatrics

111 112

121

122

123 182

STUDENT INDEX DEPARTMENT/ INSTITUTION Population Health Science and Policy Medicine, Liver Diseases, Pharmacological Sciences Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center Interdisciplinary Center for Bioethics, Yale University

POSTER POSITION

Daniel Katz, MD

Anesthesiology

128

Wetzler, Sara

James Curely-Egan, PhD

Psychiatry

129

White, Christopher

Paul Cagle, MD

Orthopaedics

130

Wolf, Amber

Sumayya Ahmad, MD

Ophthalmology

131

Xu, Emily

Emily Franzosa, DrPH

Yeshoua, Brandon

Noura Abul-Husn, MD, PhD

STUDENT NAME

MENTOR NAME

Vasoya, Roshan

Lina Jandorf, MA

Venturini, Nicholas

Scott Friedman, MD

Verma, Hannah

Javier Valero, MD, MPH

Verma, Hannah

Stephen Latham, PhD, JD

Weingart, Brett

Ying, Stephanie

Paul Sidoti, MD Joseph Panarelli, MD

Youssef, David

Jose Clemente, PhD

Zachem, Alexis

Alan Copperman, MD

Zhou, Rebecca

Richard Rosen, MD

Zhu, Jerry

Ajit Rao, MD

Geriatrics and Palliative Medicine Genetics and Genomic Sciences Ophthalmology, New York Eye and Ear Infirmary Ophthalmology, NYU Langone Genetics and Genomic Sciences Obstetrics, Gynecology, and Reproductive Science Ophthalmology, New York Eye and Ear Infirmary Surgery

124 125

126

127

132 133

134

135 139 137 138

183

184

SECTION 4:

Mentor Index 185

MENTOR INDEX MENTOR LAST NAME

MENTOR FIRST NAME

DEGREE

DEPARTMENT/INSTITUTION

POSTER POSITION

Abul-Husn

Noura

MD, PhD

Genetics and Genomic Sciences

33

Ahmad

Sumayya

MD

Ophthalmology

131

Akbarian

Schahram

MD, PhD

Psychiatry

93

Akiyama

Matthew

MD

Medicine, Albert Einstein College of Medicine

62

Ankuda

Claire

MD, MPH

Geriatrics and Palliative Medicine

103

Appel

Jacob

MD, MS, MPH

Psychiatry, Medical Education

66, 86, 91

Baum

Aaron

PhD

Global Health

80

Bogunovic

Dusan

PhD

Microbiology

82

Brennand

Kristen

PhD

Neuroscience

90

Bunyavanich

Supinda

MD, MPH

Pediatrics

46

Burnett

Garrett

MD

Anesthesiology

107

Cagle

Paul

MD

Orthopaedics

49, 130

Chaudhary

Saad

MD

Orthopaedics

4

Chehade

Mirna

MD, MPH

Pediatrics

17

Cho

Judy

MD

Genetics and Genomic Sciences

71

Cho

Samuel

MD

Orthopaedics

118

Choudhri

Tanvir

MD

Neurosurgery

56, 83

Clemente

Jose

PhD

Genetics and Genomic Sciences

135

Colvin

Alexis

MD

Orthopaedics

24, 119

Copperman

Alan

MD

Obstetrics, Gynecology, and Reproductive Science

85, 139

Curely-Egan

James

PhD

Psychiatry

129

186

MENTOR INDEX MENTOR LAST NAME

MENTOR FIRST NAME

DEGREE

DEPARTMENT/INSTITUTION

POSTER POSITION

Divino

Celia

MD

Surgery

1, 105

Do

Ron

PhD

Genetics and Genomic Sciences

38

Dubinsky

Marla

MD

Pediatrics, Gastroenterology, Medicine, Gastroenterology

8

Farhan

Serdar

MD

Medicine, Cardiology

57

Ferket

Bart

MD, PhD

Population Health Science and Policy

22

Fernando

Dinali

MD

Emergency Medicine

102

Forsh

David

MD

Orthopaedics

19, 94

Franzosa

Emily

DrPH

Geriatrics and Palliative Medicine

132

Friedman

Scott

MD

Galvez

Maida

MD, MPH

Gelb

Bruce

MD

Pediatrics

76

George

Mary Catherine

PhD

Neurology

51

Gorbenko

Ksenia

PhD

Population Health Science and Policy

97

Goukassian

David

MD, PhD

Medicine, Cardiology

106

Guttman

Emma

MD, PhD

Dermatology

21, 30, 70

Hadjipanayis

Constantinos

MD, PhD

Neurosurgery

116

Hayden

Brett

MD

Orthopaedics

109

Heeger

Peter

MD

Medicine

64

Hennig

Nils

MD, PhD

Pediatrics

55

Hollon

Todd

MD

Neurosurgery, Michigan Medicine

45

Medicine, Liver Diseases, Pharmacological Sciences Environmental Medicine & Public Health, Pediatrics

96, 125 68

187

MENTOR INDEX MENTOR LAST NAME

MENTOR FIRST NAME

DEGREE

DEPARTMENT/INSTITUTION

POSTER POSITION

Holodny

Andrei

MD

Radiology, Memorial Sloan Kettering Cancer Center

95

Jandorf

Lina

MA

Population Health Science and Policy

124

Jette

Nathalie

MD

Neurology

122

Jin

Jian

PhD

Pharmacology and Systems Therapeutics

29

Katz

Craig

MD

Medical Education

26, 53

Katz

Daniel

MD

Anesthesiology

28, 128

Kayal

Maia

MD

Medicine

67

Kelley

Amy

MD

Geriatrics and Palliative Medicine

104

Kellner

Christopher

MD

Neurosurgery

61, 99

Kim

Jun

MD

Orthopaedics

52

Kushner

Tatyana

MD

Medicine

48

Kwon

Churl-Su

MD, MPH

Neurosurgery

115

Lagana

Alessandro

PhD

Latham

Stephen

PhD, JD

Lee

Alison

MD

Livanos

Alexandra

MD, PhD

Medicine

35

Londino

Aldo

MD

Otolaryngology

32

Lu

Theresa

MD, PhD

Microbiology and Immunology, Hospital for Special Surgery

73

Masci

Joseph

MD

Medicine

39

Mazor

Melissa

PhD, MS, RN

Medicine

11

Oncological Sciences, Genetics and Genomic Sciences Interdisciplinary Center for Bioethics, Yale University Medicine, Pulmonary, Critical Care and Sleep Medicine, Pediatrics

74 127 6, 121

188

MENTOR INDEX MENTOR LAST NAME

MENTOR FIRST NAME

DEGREE

DEPARTMENT/INSTITUTION

POSTER POSITION

McVane

Ben

MD

Emergency Medicine

102

Mehandru

Saurabh

MD

Medicine

35

Mogilner

Leora

MD

Pediatrics

65

Moucha

Calin

MD

Orthopaedics

54, 109

Munjal

Kevin

MD, MPH

Emergency Medicine

113

Nadkarni

Girish

MD, MPH

Medicine

59

Navis

Allison

MD

Neurology

122

Oermann

Eric

MD

Neurosurgery, NYU Langone Health

45

Ornstein

Katherine

PhD

Geriatrics and Palliative Medicine

88

Palermo

Ann-Gel

DrPH

Medical Education, Pediatrics

69, 100, 123

Palese

Michael

MD

Urology

72

Panarelli

Joseph

MD

Ophthalmology, NYU Langone

134

Pandis

Dimosthenis

MD

Cardiovascular Surgery

31, 58

Parsons

Ramon

MD, PhD

Oncological Sciences

5

Pasquale

Louis

MD

Ophthalmology

43

Pavel

Ana

PhD

Dermatology

70

PerezRodriguez

M. Mercedes

MD, PhD

Psychiatry

60

Poeran

Jashvant

MD, PhD

Population Health Science and Policy

4, 23, 27, 92, 98, 109

Ramirez Zamudio

Andres

MD, MPH

Obstetrics, Gynecology, and Reproductive Science

112

Ranade

Sheena

MD

Orthopaedics

18

Rao

Ajit

MD

Surgery

138

189

MENTOR INDEX MENTOR LAST NAME

MENTOR FIRST NAME

DEGREE

DEPARTMENT/INSTITUTION

POSTER POSITION

Redberg

Rita

MD

Cardiology, UCSF

14

Rice

Timothy

MD

Psychiatry

41, 91

Ripp

Jonathan

MD, MPH

Medical Education

63, 117

Rojas

Mary

PhD

Medical Education

10

Rommel

Anna

PhD

Psychiatry

114

Rosen

Richard

MD

Ophthalmology, New York Eye and Ear Infirmary

3, 137

Sachar

David

MD

Medicine

40

Sainté Willis

Michelle

Medical Education

123

Pharmacology and Systems Therapeutics, Fralin Biomedical Research Institute at VTC (Virginia Tech) Dermatology, UNC Chapel Hill School of Medicine, Chapel Hill, NC

Sassi

Yassine

PhD

Sayed

Christopher

MD

Schaefer

Anne

MD, PhD

Neuroscience

2

Sebra

Robert

PhD

Genetics and Genomic Sciences

20

Shrivastava

Raj

MD

Neurosurgery

34

Sidoti

Paul

MD

Ophthalmology, New York Eye and Ear Infirmary

134

Simon

Viviana

MD, PhD

Microbiology

12

Singer

Elizabeth

MD, MPH

Emergency Medicine

44

Smith

Cardinale

MD, PhD

Medicine

11

Soriano

Rainier

MD

Geriatrics and Palliative Medicine

27

Stanley

Sarah

MBBCh, PhD

Neuroscience

50

Stern

Toni

MD

Obstetrics, Gynecology, and Reproductive Science

36

15 101

190

MENTOR INDEX MENTOR LAST NAME

MENTOR FIRST NAME

DEGREE

DEPARTMENT/INSTITUTION

POSTER POSITION

Sun

Weina

PhD

Microbiology

84

Taioli

Emanuela

MD, PhD

Population Health Science and Policy

89

Taouli

Bachir

MD

Radiology, Translational and Molecular Imaging Institute, New York, NY

111

Taub

Peter

MD

Surgery

77

Ting

Windsor

MD

Surgery

13

Ungar

Benjamin

MD

Dermatology

78

Ungaro

Ryan

MD

Medicine

16

Vaid

Akhil

MD

Genetics and Genomic Sciences

59 126

Valero

Javier

MD, MPH

Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center

Vreeman

Rachel

MD

Global Health, Pediatrics

47, 80, 81

Wang

Linda

MD

Medicine

108, 110

Wong

Sze

MD

Wright

Rosalind

MD, MPH

Zaidi

Ali

MD

Medicine, Cardiology Pediatrics

79

Zajac

Lauren

MD, MPH

Environmental Medicine & Public Health, Pediatrics

25, 42

Zhang

Linda

MD

Surgery

9, 120

Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai Pediatrics, Pulmonary and Critical Care, Environmental Medicine & Public Health, Medicine, Pulmonary, Critical Care and Sleep Medicine

87

37

191

192

SECTION 5:

Abstracts Topics Area 193

ABSTRACT TOPICS AREA CATEGORY

POSTER POSITION

Adolescent Health

79

Allergy and Immunology

64, 73, 82

Anesthesiology, Perioperative, and Pain Medicine

28, 107, 128

Cardiology

14, 15, 57, 59, 76, 106, 126

Cardiothoracic Surgery

31, 58

Dermatology

21, 30, 70, 78, 101

Diagnostic, Molecular and Interventional Radiology

111

Education

123

Emergency Medicine

113

Endocrinology, Diabetes, and Bone Disease

45, 50

Environmental Medicine & Public Health

6, 37, 42, 68

Family Medicine & Community Health

110

Gastroenterology

8, 16, 35, 40, 67, 71, 135

General Surgery

66, 105

Genetics and Genomic Sciences

33, 38

Geriatrics and Palliative Medicine

11, 27, 88, 103, 104, 132, 133

Global Health

9, 26, 39, 44, 47, 55, 80, 81, 102, 114, 120

Health Policy/Population Health

10, 22, 97, 100, 124, 127

Health System Operations & Strategic Planning

23, 69

Infectious Diseases

12, 62, 99

Liver Diseases

48, 96, 125

Microbiology

84 194

ABSTRACT TOPICS AREA CATEGORY

POSTER POSITION

Neurology

51, 122

Neuroscience

2, 90, 93

Neurosurgery

34, 56, 61, 83, 95, 115, 116

Obstetrics, Gynecology, and Reproductive Science

36, 85, 112

Oncology/Hematology

5, 20, 74, 89

Ophthalmology

3, 43, 87, 131, 134, 137

Orthopaedics

4, 18, 19, 24, 49, 52, 54, 92, 94, 98, 109, 118, 119, 130

Otolaryngology-Head and Neck Surgery

32

Pediatrics

17, 25, 46, 65

Pharmacological Sciences

29

Psychiatry, Psychology, Mental Health

41, 53, 60, 86, 91, 117, 129

Pulmonary, Critical Care and Sleep Medicine

121

Substance/Alcohol Use Medicine

108

Surgery

1, 7, 77

Urology

72

Vascular Surgery

13, 138

Well-Being & Resilience

63

195

196

SECTION 6:

Acknowledgements 197

POSTER SESSION FACILITATORS Stephanie H. Factor, MD, MPH Medicine, Infectious Diseases, Obstetrics, Gynecology and Reproductive Science Darinka Gadikota-Klumpers, PhD Medical Education, Program Director for Global Health Education David Heller, MD Global Health, Medicine, General Internal Medicine Joanne Hojsak, MD Pediatrics, Pediatric Critical Care Medicine Geoffrey Jara-Almonte, MD Emergency Medicine Kalypso Karastergiou, MD, PhD Medicine, Endocrinology, Diabetes and Bone Disease Daniel Katz, MD Anesthesiology, Perioperative & Pain Medicine, Obstetrics, Gynecology and Reproductive Science Stanislav Lazarev, MD Radiation Oncology Amanda Leiter, MD, Medicine, Endocrinology, Diabetes and Bone Disease Thomas Marron, MD, PhD Medicine, Hematology and Medical Oncology Peter Morgenstern, MD Neurosurgery, Pediatrics

Jashvant Poeran, MD, PhD, Population Health Science and Policy, Orthopedics, Medicine Mary Rojas, PhD Medical Education Barbara Sampson, M.D.- Ph.D. Department of Pathology, Molecular, and Cell Based Medicine Perry Sheffield, MD, MPH Environmental Medicine & Public Health, Pediatrics Richard Silvera, MD, MPH Medicine, Infectious Diseases Elizabeth Spencer, MD Pediatrics, Pediatric Gastroenterology Joanne Stone, MD, MS Obstetrics, Gynecology and Reproductive Science Christopher Strother, MD Emergency Medicine, Pediatrics, Medical Education Talia Swartz, MD, PhD Medicine, Infectious Diseases, Medical Education Maaike Vangerwen, PhD Otolaryngology Lauren Zajac, MD, MPH Environmental Medicine & Public Health, Pediatrics 198

EVENT COMMITTEE Mary Rojas, PhD Director, Medical Student Research Office Associate Professor in Medical Education Jenny J. Lin, MD, MPH Associate Director of SCHOLaR Professor of Medicine/General Internal Medicine Keith Sigel, MD, PhD Director, PORTAL Program (MD/MSCR) Associate Director Research Associate Professor of Medicine/ General Internal Medicine Grace A. Oluoch, MBA Senior Program Coordinator Medical Student Research Office Yakhira Encarnacion-Patterson, MPH Senior Program Coordinator Medical Student Research Office

199

200